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rJ117LE Current Feseacch on Sleep and Dreams. INSTITUTION National Inst. ot Mental Health (PHEW) ,Bethesda, Md. PUN DATE b5 NO.E 134. AVAIIABIL FECtv. Superintendent ct Documents, U.S. Government Printing Office, Washington, D. C. 20402. ($.t5 per copy)

FURS EBICl EDFS Price MI-$0.6t hC Not Available from EDRS. DESCRIPIORS Behavior, Literature Reviews, Psychological Patterns, *Research, Research iiethcdolcgy, *Ecsearct Leviews (Publications), *Fesearch Tools, *Sleep IDEN71FIEFS *Dreams

ARSIRACI This monograph summarizes an extensive body of sleep and dream research in order to indicate the mujor trends of work in this area. Alttough a mosaic of disciplines are represented, a spirit cf cooperation has made it possible to knit together data which might have remained unrelated. The research reported here provides knowledge about: (1) the nature of sleep; (2) the ccmplem interrelatedness ct the brain; (3) the explanation of sleep discraeis; (4) the chemistry of sleep; and (5) new instruments and techniques of analyzing data. The document suggests that one of the great contributions ct sleep research could he the enlargement of human capacities and the enrichment of human consciousness. In summary, the study ct sleep has extended its benefits into medicine, pharmacology, psychiatry, into the scheduling of work and rest, and into the education of the individual acguainting him with himself and the uses of hie remarkable train. (TI) fi

Current Research

on Sleep and Dreams

II S DEPARTMENT 0:: HEALTH, fOuCATJON WELFARE OFFICE OF EDUCATION TM,S DOCUMENT HAS BEEN ,E^RODUCED EXAC1LY AS .ECEIVID FROM THEPERSON OR ORGANiZATiON ORiGiNATANG ItPO,Ntb OF VIEW OR OPINIONS STATEDDO NOT WES SARILY REPRESENT Of FiCiAl OFTKEOF IOU C4TION POSitiON OR POtrcv

U.S. DEPARTMENT OF HEALTH, EDUCATION,AND WELFARE PUBLIC HEALTH SERVICE NATIONAL INSTITUTES OF HEALTH Bethesda, Md. 20014

CY" NATIONAL INSTITUTE OF MENTAL HEALTH rr' RESEARCH GRANTS BRANCH 0 1 8 Th's report and the prior individual reports on which it is largely based were written by Mrs. Gay Gaer Luce, who received the consulting aid of Dr. Dennis McGinty. The effort was coordinated by Dr. Julius Segal and his staff of the Program Analysis Section, Research Grants Branch, NIMH. The project was made possible by the generous and gracious collaboration of the scientists whose research is described here, and this invaluable. assistance is gratefully acknowledged by the Institute.

Public Health Service Publicoi;on No, 1389

For sa/e by tie Superintended of floaimenlg, V.S. Government hinting Office Washington, D.C., 20477Fr!oe 63 cent, 2 Foreword This monograph was stimulated by the extraordinary growth now apparent in an area generally identified as sleep and dream research, for this recent concentration of scientific effort offers a singular example of the power that basic research can exert in penetrating the pro' ems of mental health and illness. In the past year alone, the National Institute of Mental Health supported over 60 projects related in whole or in part to studies of sleep and dreams, with awards totaling over $2 million. The work of many of these MMII investigators is included in this summary, which extends beyond the Institute's program insofar as necessary to indicate the major trends of work in the area. The report cannot, of course, encompass the classical studies already sum- marized in published literature, nor even provide a comprehensive survey of present-day sleep research, for although much of the scientific data on sleep have been generated during the last dozen years, significant referewes in this field now number in the many thousands. The mosaic of disciplines contributing to the study of sleep contains such diverse fields as psychiatry, and mathematics, psychology, and biochemistry, physiology, and anthropology. Nevertheless, ferment about the subject :natter and a spirit of cooperation across traditional disciplinary lines have made it possible to knit together data that might otherwise have lain unrelated in a variety of laboratories. During the past year, individual summaries of maly of the projects cited here were distributed to scientists working in the field of sleep and drums. Many of theecipients felt, that upto-date reports, especially in a field of such dynamic activity, represented a unique solution to the problem of scientific information exchange. Such communication, it was felt, provided a quick look at work in progress that might prevent duplication of effort and stimulr.to pertinent contacts among scientists, this aiding them in their work.It is hoped that this monograph will be a further part of that process. SAP1R, O1 ie /, Bertearch Grants' Branch, National Institute ofMenialHealth.

HI Table of Contents Page Foreword. jj Introduction_ Clocks Within the Body 3 Cycles and Illness 4 The Circadian Rhythm 4 Cycles and Medicine 6 Cycles and Work Schedules 6 A Night of Sleep 9 The Electroencephalograph 9 The Sleep Laboratory 10 "The Laboratory Effect" 10 Drowsiness 11 Stage 1_ Stage 2 11 Stage 3 11 Stage 4 11 Stage 1 REM 12 The Whole Night 13 Analysis of the EEG. 14 Summary_ 17 Sleep Deprivation 18 Temporary Psychosis 19 The Role of Ago 20 Ihysiologieal Changes 21 Energy Metabolism 22 Psychological Changes Steep Loss and Performance 24 Summary 27 Sleep Disorders 28 Insomnia 28 A Neural Pacemaker 29 Sleep Disorder and Mental Illness 30 Common Disorders 31 Somnambulism 32 Evoked Potentitds 33 Encephalitis 34 Narcolepsy 34 Epilepsy. 37 Single Brain Cell Studies 38 Summary 39

4 Page The Chemistry of Sleep 41 Alcohol 43 Dexedrine___ 43 Barbiturates 44 Antidepressants 45 LSD-25 45 A Possible Itypnotoxin 46 C VIM a-itydr oxybu ty rat e 47 Reserpine 4S Dopa _ 49 Serotonin_ 49 Hormones 50 Acetylcholine and Noradrenalin 52 Chemical Brain Mapping 53 "Motivation" and Sleep 55 Control Over Sleep and Other States of Consciousness 56 Control of the Alpha Rhylmi 57 Voluntary Control and Psychosomatic Medicine 59 Sleep Learning_ 59 Discriminations During Sleep 61 Performance During Sleep_ 02 Memory 62 Experiments in Discrimination 63 Sleep Learning in Hypnotic Subjects__ 64 Habituation 65 Conditioning Seep_ 66 Sleep Habits 66 The AM akening PfUL 2SS 64. Summary 68 The Dream State of REM 69 The REM Cycle 70 REM Deprivation 70 Personality and EEG Differences in Cats 73 Partial Dream Deprivation 74 Muscle Tone 74 Physiological Excitation 75 Cardiorespiratory Changes 75 Oxygen Consumption 76 Brain Temperature 77 Biochemical Changes 77 Erection Cycles 78 The Eye Movements 7S Similarities to the Waking Brain 80 A Difference From the Waking Brain 81 The Neuroanatomy of the REM State 82 Is the REM State Part of Sleep? 83 Animal Dreaming 85 A Limit to REM Compensation SO Experiments in the Biocheini:'ry of REM Sleep. 87 REM Deprivation Pim Brain Excitation 88 The Biological Purpose of the REM State 89 Summary 89 vl Page The Development of Infant Sleep_ 91 The Decline of REM Sleep with Age 91 Cortical Development in Kittens 93 Diagnostic Possibilities 94 The Meaning of Dreams 96 Influencing Dream Content 97 Dream Recall 98 Dream Intensity 99 Sti:nulation Before Sleep 99 Classifying Dreams 100 Speculations About the Neural Basis for Dreams 101 DriN e Mechanisms in REM 102 Good Sleep and Poor 104 EEG Differences 104 Physiological Differences 105 Psychological Differences 106 Sleep Quality and Constitution 106 Summary 108 References 112

vii Own e, Sleepe / 0 sleepe, the certaine knot of peace, The Baiting-place of wit, the balm of lace, The pore man's wealth, the prisoner's release ... Sir Philip Sidney

Introduction During the last decade, the study of sleep has The exploration of sleep is very new in its cur- provided an aperture for the astronomers of the rent dimensions, yet it has already contributed mind. Scientists of many disciplines, using differ- toward the clinical diagnosis and treatment of ent instruments mid inspired by different interests, narcolcpsy, toward behavioral predictions in sev- have converged onto that nighttime universe only eral mental disorders, toward an understanding to discover that they were exploring related events, of the effect;; of drugs and more sensitive drug fundamental processes involved in mood, behav- therapy, and toward an understandir.g of infant ior, memory, and development, sanity and psy- development.Sleep disorders are characteristic chosis, health and illness. of many mental illnesses, and there are also many The study of sleep has become something of a illnesses that manifest symptoms frequently dur- scientific vogue, but unlike social fads, it is based ing sleepepilepsy, enuresis, asthma. The impli- upon sound scientific strategy,Sleep is a funda- cations of sleep research for general medicine can mental biological process whose mechanisms are be illustrated in a single example: coronary at- providing unforeseen insights into man's behavior. tacks, often fatal, tend to occur during the early The convergence of efforts by many researchers in morning hours when people aro most likely to be a variety of scientific enterprises has resulted in in a particular phase of sleep, attended by certain the rapid development of new techniques and prac- dist met physiological changes. tical khowledgeespecially with regard to the Tho control of sleep behavior could become an brain's activity, for the study of sleep is perhaps enormous asset in the modern world. In the next the most active single approach to the exploration decades people may learn how to indve and ter- of the brain itself; the alternation of sleeping and minate sleep at will, and establish more effective waking form the physiological background act is-- schedules of work and rest, perhaps even reduc- ity of the brain. ing the normal sleeping time.In our exploration Sleep is au interruption of waking conse,ousne.ss of the mechanisms governing sleep and the capac- and the exercise of intelligence..It may be one ities of the sleeping person, the door is opening of the most essential needs of higher mammals. upon the amplitude, the unexploited richness, of The mechanisms that control sleep and waking are man's consciousness. intimately related to those of emotion and atten- All men sleep.Between the darkness out of tion. Without understanding this essential phase which we are born and the darkness in which we of nervous activity, we aro not likely to fathom end, there is a tide of darkness that ebbs and flows the organization of memory or learning. One each day of our lives to which we irresistibly phase. of sleep appears in the brain activity of the submit. A third of life is spent in sleep, that unborn baby, and it persists throughout life, pos most total yet profoundly mysterious realm of sibly holding a key to the development of the hu- consciousness where the person seems to live apart man brain and personality.The sleeping state from the waking world, often immobile, some is a convenient one for many kinds of brain studies, times appearing to be departed. Why all of this because the sleeping creature normally lies still and sleep? Why does the animal world plunge into rear's very little to external stimuli. these periods of stillness?

7SS-1,27 1 - 2 7 We have not yet answered that question, but we stead, many shadesthat sleep itself is not un- are beginning to track some of the unseen forces conscious, ar.d that the forgotten darkness of each that govern the rhythms of our lives, clocks with- night contains periods of intense inward con- in our own substance that strike the tempo ac- sciousness and many varieties of thought.It is cording to which we wake or dref.m, chemicals not oblivion that is studied in the exploration of that cause an ebb and flow of consciousness. For sleep, but the entire realm of man's mental being. What now emerges from the laboratory may bring the first time science is gaining a glimmer of the to all mankind the possibility of learning the ex- miraculous machinery of the mind at times when traordinary feats of mental and bodily control it is speaking only to itself. shown by singular individuals.Slowly, these are Although we have always conceived of sleep becoming an open secret. Thus sleep, the private and waking as the light and dark of human con- world of darkness and rest, may open to man his sciousness, we have discovered that there are, in- full abilities.

2 Whatever may be the multiplicity or contrariety of opinit .18 upon this subject, nature has taken sufficient care that theory shall have little influence upon practice.The most diligent inquirer is not able long to keep his eyes open: the most eager disputant will begin about midnight to desei' his argument; and, once in every four- and - twenty hours, the gay and the gg'oomy, the witty and the dull, the clamorous and the silent, the busy and the file, Ere r,l1 over- powere, by the gentle tyrant, and all lie down in the cquali'±y of sleep .. Sit And Johnson

Chapi,-r I.Clocks Within the Uody Before electricity, light was precious, difficult negated by Dr. Nall, niel Kleitman, a physiolo- to roduct and expensive to buy, and most of the gist whose systeniati..! Audies of sleep have pro- human world retired when darkness fell.The vided inspiration for touch of the current work. custom of sleeping through the night probably Kleittnan and his dar;_diter interviewed the towns- stems from the lorg history of necessity. Perhaps people of Tromso, in ',hat northern coastal region, nightly sleep, or at least the general habit of man- and found that they;31ept about 7 hours a day in kind of sleeping many hours at one stretch, is the the summer and onlyan hour longer in the winter. stamp of this history upon the organization of our Other Arctic studies; offer about the same figures, bodies. einphasWng that mot's sleep is not sclely deter- Insofar as we, know, people the world over mined by light andidark(Kleitman and Melt- sleep between it and S hours at a stretch, usually man, 1953: Semagill, 1061). at night.If this were sheer custom one might ex- Social customs and the orgapization of wink pect to hear about cultures with other habits, per- and restare orie 'Ited around light and dark haps places where naps const fluted the entire sleep throughout the eta rid, and nightly sleep is the of people, places where steep was equally appor- predominant patteln.This appears to be cluing. tioned as inc. our three meals a day.Such cul- ing somewhat in urban societies. where some in- tures may somewhere exist, but they Iv .e not been dustries and profe.sions demand night work, por- reported. tending a 211101,: operation.The data proc- In Spain and many Latin countries, of course, essing center in Pockefellev Plaza, for instance, there is the custom of the afternoon siesta, a long is in mnstant ape'ation as are newspapers, radio, nap.Nevertheless, people in these countries sleep '11 -, creating professions to which ninny night some 5-7 hours again at night. A visitor to Bali peopio, so called, ire attracted.Many people in has claimed t hat the Balinese do not sleep all night, urban centers apiwar to prefer night activity and for they sing when they arc awake and there is day-long sleep.Ferenc Molnar, the playwright, no time of day or night when singing cannot be was so extreme in this respect he is said to have heard in the villages.Unfortunately, such an- seen daylight only on a rare occasion. ecdotalreporting inspiresfaulty conclusions. There is Casual reports from tourists once suggested that a story that he. had to appear in court as a witness the northern Norwegians slept remarkably little one niorning, and t s friends taxied hint Mt 0 t own during the summer. Travelers had made this in- about an hour after his normal retiring time, Mol- ference after cruises along the coast, for in this nar blearily looked out at the springtime streets season of the midnight sun there were always of Budapest, and could not believe that so many townspeople along the docks, whatever the time. people would be nu and about. "Are they all wit of day or night.However, Om conclusion -vac tic es? he wanted to know. 9 3 Although not every one does his sleeping at ing literature on such cyclical mecnanisms as oxy- night, everyone, it appears, sleeps for a long in- gen metabo7ism in simple organisms, and biol.og- terval once in every 24 hours. We do not Imow ical clocks within many forms of life, but in the whether there is any intrinsic need to sleep many higher organisms there are many internal rhythms. hours at a stretch, or whether we require some Within the human body it is safe to assume that absolute amount of sleep that might be differently there is a constant interplay of different cycles, apportioned.Unt 1 other practices are found whose time periods and effects upon our lives fall among human cultures or demonstrated in the lab- beyond the scope of present knowledge. oratory, we have reason to assume that our sleep Cycles and Illness schedule is interknit with a system of physiological Man's days, his nights, his diseases, his times of periods that revolve, like the earth, around an trouble, periods of confusion, moments of darty, axis of 24 hours. The survival of a species is may well be determined and balanced by a delicate served by rhythms, biological clerks that are and vastly complex intermeshing oi biological time adapted to nature's periodicities. Such rhythms cycles.We are accustomed to recognizing the are found in all forms of life and seem to be among most obvious and predictable periodsinfancy, their mos.' hasic characteristics (Kleitman, 1963; childhood, maturation, and old agealthoegh we Murray press; Richter, 19(35). Although they know little about the mechanisms taat make this are usually related to cycles in the environment, schedule of life so predictable.Some internal such as light and dark, they will persist for long cycles, like the 28-day menstrual cycle are well periods even in the absence of such environmental known; however, the individual pays little atten- change.The morning-glory is known to every tion to most of his physiological cycles, indeed child for blooming by day and closing at night. remains ar, sware that his fluctuations ae periodic Similarly, algae, insects, and vertebrate creatures Dr. Curt Richter of Johns Hopkins oitserved that have inbuilt cycles.The owl and the bat are many uncommon physical disorders follow odd nocturnal, but most higher mammals are diurnal, periedicities ranging from 48 hours to 17 months. sleeping in darkness and waking in light (Ber- Thee are other illnesses whose symptoms rise, and lucchi and Strata, 1062). Man is no exception to fall in cycles of 7 days or 52 days. Such ailments this internal patterning. as swelling of the knee, certain lymph disorders There may be a relatively simple explanation for and psychoses appear to grew acute in a periodic the nocturnal activity of some animal species. The fashion (Richter,1965). II chter has speculated cat is such an animal, and something is known an hypothesis we are not nor capable of confirm- about the mechanism in the cat.His neevous ing- -that the body's many metabolisms have par- system typears to be directly responsive to dark- ticular cycles of activity, andthatthese are gener- :lax A sensory apparatns within the eya dis- ally out of phase so that the system as a whole is patches neural impulses when light stimulation rather constant.But shock, emotional trauma, or stops (Arduini and Pinneo, 1962, 1063). This is allergic shock might so jar the system that some of known as the dark discharge of the retina. Dr. A. tiles: components become synchronized, causing the rdnini and his CO7e0Ti,,CS rt the University of whole system to wax and wane in phase with Pisa have shown that this dark discharge has an themwith ainpliticd effects known as illness. Al- arousing effect upon the cat.If other conditions though this is a very empyrean speculation at the remain constant the cat is more likely to be awake moment, it r my prove i.ertinent, when wo are able and alert during darkness, and this phenomenon to tamper seriously with ntan's sleep cycles, and it has been shown to be (Inc to dark discharge from the retina.By eliminating the dark discharge may suggest some long -ter in links in the etiology of sleep disorder and mental disease, for the two are from the retina in laboratory .studi?:;, the experimental cats were prevented from showing their commonly associated. natural tendency to come alert during darkness. The CIrcadlan Rhythm This connstion, which has been established ex- Although biological i':'riodicities may play a perimentally between the dak-sensitive retina of very large role in our lives, we are influenced by the cat's eye and the creature's arousal system in them unaware, and have done little to utilize any the baFt,. of its b "ain, helps to explain a cat's pref- but the most gross periods for (It. benefit. Most er Awe for night prowling. There is now a grow- people do not realize that their body temperature

4 10 des rhythmically about a degree or two every Presumably an 'nterlocking of many metabolic ele- . This circadian temperature rhythm (from ments is involved. New information on the cir- Latin "circa dies," meaning about a day) exists cadian temperature rhythm, diurnal sleep cycle, o: about the third month of life, perhaps in- and body chemistry may come from attempts to ited from the, mother's cycle.With almost develop a drug that lowers man's body temperature klike regularity the body temperature rises and and oxygen consumption, putting him into a state each 24 hours.The highest temperature is comparable to seep. A drug induced hibernation, ly to coincide with a person's "best hours" of so to speak, mig it entail a drastic alteration in the :efulness, his favorite time of day, the time circadian rhythm and has many possible applica- in he feels most alive and alert. The nadir gen- tions if the trick can be performed without injury. ly occurs in the late hours of sleep. If a person At present, however, we have had notably little pens to be awoke during this low-temperature success in expahrling or contracting the cycle in eid he may sense a slump in his vitality and adult animals. Using environmental change it has feel chilled. The high temperature period is been possible to modify cycles in termites, crus- related with the muscular tension we exhibit taceans, and invertebrates, hardly tantamount to n awake and the low temperature is associated altering the circa dian rhythm in higher mammals, the relaxation of our muscles during sleep, but we are meanwhile learning a good deal about the cause of the temperature cycle is unknor. n. rhythms by shifting the phase of the daily cycle may result from an intermeshing of many so that the peak and nadir temperatures, while in abolic periodic ities. Whatever its origins, the the same relatior to each other, occur at a different adian temperoture cycle appears to be quite time than norma I to alter in the normal adult. 3Ian and his :ousin primates are the only ani- ne of the mos:, famous attempts to shift from mals with very ilronounced diurnal cycles, waking I-hour cycle to another schedule took place in by day, sleeping through the night.Macaque and nmoth Cave Ky., in June :938.Nathaniel rhesus monkeyf are typically active for 12-16 itman and a student descended into a chamber hours, and then apse into a long period of inactiv- ool and unchanging temperature, where silence ity (Rhodes, 19E1; Weitzman et al., 1964).In one unbroken; darkness absolute bet for electric effort to discover the controlling factors in this .t.There, in a cave usually traversed by tour- cycle three infir it monkeys were raised in a con- , ley set up living quarters and tried to shuck stant environm( nt, always dark excepting for 1 24hour day. They were not shooting for ex- hour of dal'useliglA each day. The monkeys were ao changesjust a 21-hour day and a 28hour put on different feeding and light schedules for . It seemed easier to compress the cycle than periods 3-5 weeks.Changes in feeding time tretch it.Kleltman, then in his early forties, did not affect t re monkeys, but when the daily id that he ad:lilted less easily than the younger hour of light 'vas shifted, the animals would I.When he t' led to follow the sleep schedule slowly show an activity cycle that stabilized 6-day wee': (a 28-hour day) his body stub - around the time of the light.Light seemed to ily shemcd the temperature cycle of a v -day have a greater i npact, on their daily fluctuations k.Although A group of explorers reported than did food (Lindsley et al.,1962). owing a 21- and 21-hour day in the arctic sum- Light evidently affects the nervous system and , nobody has over managed a 30- or 48-hour physiological function in profound ways that we . The 24.hour temperature cycle tends to are just beginnit g to uncover (Lisk et 11., 1965). at radical mollification insofar as we know In many minim for instance, light enhances eit man, 1963). pituitary-gonadal functioning.Direct light to e know very little about the fluctuations in hypothalamus, shone through implanted tubes, has y chemistry that accompany this regular rise produced in rat: a continuous estrouslike cycle, fall of temp:trail:re.The adrenal glands with a rise in ova' ian weight and pituitary weight. lute hormones whose concentration in the urine In ducks, other studies have shown that ti.reet aws the same ri:e and fall as body temperature. light to certain ')rain regions stimulated the go- .ilarly, the concentration of eosinophils in the nads.Thus, light itself affects the central nerv- )(I mirror the 21-hour cycle: these are a special ous system so as to influence steroid production, of white blood cell produced in bone marrow. thereby influenci tig reproduction.Not all of the physiologically influential light need be coming studies, demonstrably responsive to the different through the eyes.Sunlight, it has been shown, phase points on the daily temperature cycle.'The can penetrate the hypothalamus of sheep, dog, rab- effect of X-radiation during the animal's subjec- bit, and rat, perhaps in this way affecting the tive night was far worse than during subjective periods known as breeding seasons. day.After radiation all the mice became very Cycles and Medicine sick, but those irradiated at 9 a.m. eventually re- Despite the existence of night people and the covered, whereas those irradiated at 9 p.m. did not fact that we have no clear understanding of the recover.Those irradiated between midnight and At high, al- role of light in our diurnal rhythm, it is possible 4 ant. were maximally vulnerable. that light affects our nervous systems in such a most lethal dosages, the animals had some chance way as to orient our circadian rhythmacting as of surviving X-radiaticn if it occurred during cer- an entraining agent. tain phases of their circadian cycle, but their Because it has this effect. chances diminished at other points on the cycle, upon lower animals, experimentalists have used illumination schedules to stabilize the circadian and they were doomed if it occurred at their interval of greatest sensitivity (Pizzarello et al., 1960. rhythm in studies that may have vast implications for human welfare.Our temperature cycles and Judging from animal studies, and from the very subcycles may exert a towerful influence on our fabric of the language in which man describes sub- behavior, attention ability to work, re- jective waxing and waning of strength, it would sponse to illness, even our capacity to survive. seem that the circadian temperature cycle holds Hospital personnel, for instance, make the casual many implications for understanding behavior observation that the predawn hours are often the and illness, and for the timing of treatments.If, fatal ones for critically ill people.They are a indeed, most patients are highly vulnerable dur- time of many coronaries. Is there a correlation being the dawn and early morning hours, some tween events in the temperature cycle of patients changes in hospital schedules might be warranted. and their time of death (Snyder et al., 1961) ?If During the past year a reported discussion among the/ow temperature period coincides with the time medical doctors suggested that surgery should riot of symptom intensity and crisis, one might expect be scheduled too early in the morning if possible the people who work all night to show a crisis tend- and that the traditional hospital regimen may dis- ency that falls at quite different hours than peo- turb patients too early.At this point there are ple who work by day.Animal experiments sug- no organized data on the relative merits of timing gest, that there are regular low activity periods and hospital procedures or clinic treatments differ- these may indeed be intervals of physiological ently, and until recently there has been no reason- vulnerability. able way of obtaining continuous body-tempera- Experiments on rats have indicated that the ture readings from acutely ill patients without animals are particularly vulnerable to the botuli- disturbing them.Procedures for using very small nus bacillus during their inactive periods, so dif- thermistors are being developed in several places, ferentially sensitive that the time of injection may among them the Downstate Medical Center in determine whether there is acute illness, like that New York.Statistical information about the in- of food poisoning, or death.The daily rhyth- fluence of man's tcruperature cycle may generate mieity appears to pervade the metabolic system, means of gauging an individual's inner timing, and animal studies have shown up differential re- periods of strength and weakness, and may also sponsivity to temperature, ultraviolet. light, and help to understand the elIcet of this daily cycle drugs.Within the laboratory an artificial light- upon the performance of people at work, upon ing regimen can help to stabilize the phase orienta- emotional fluctuations, and the ability to with- tion of the anklets' temperature cycles. When stand stress.The temperature cycle may also maintained on light for the 12 hour reriod behold useful clues to the timing of symptoms in tween 7 a.m. and 7 p.m., and dark the remaining disease and mental disorder. hours, two strains of mice showed particular vul- Cycles and Work Schedules nerability to X-radiation when the dosage was At present, the working world abides by a clock administered at midnight, 19 hours after the be into which individuals must tit as best they can. ginning of the light cycle.The survive.] of mice Although it may be of considerable practical conse- after high-intensity irradiation was, in e. series of quence to us we know very little about the itqler- 6 12 action of the circadian temperature rhythm with schedule ought to enable a man to remain very the external schedule. Researches inspired by dif- steady in his performance and not render him ferent aims suggest that temperature cycles may unduly vulnerable to stresses such as sleep loss. offer valuable guidelines by which people could Alluisi and his coworkers have found that a short perform at their best ai,d avoid performing at period of sleep loss seems to reveal the practicality their worst if they scheduled their most demand- or performance endurance of work-rest schedules. ing work for periods of higher temperature and By using a 48-hour period of sleep deprivation, avoieied commitments during the interval of their they have found that performance is far more un- nadir (Loveland and Williams; Williams, Lubin, even on a 4-2 schedule than on a schedule of 4-hour and Goodnow; Wilkinson, in press; Alluisi, et al.; (int). and 4-hour rest.The stress of sleep loss has Murray, et al., 1958). In the course of a somewhat been used as a means of distinguishing between repetitive daily schedule, people do undoubtedly schedules. orient themselves more-or-less according to their Some scientific questions raised by the prospect cycle. However, rapid communications, jet travel, of space flight should lead to research which, in and requirements for round-the-clock productivity turn, should reveal more information about the are becoming more common, are disrt nting the nature of our circadian cycle and its influence in regularity of the work schedule, and demanding our lives, information that would be of immense greater flexibility of many people.Surely, space practical value. We do not. now know what would travel will impose round- the -clock demands upon happen to an individual if he were placed in a the first venturers, and in looking forward to these timeless, unchanging environment, a place of no a number of studies have been made on men who clocks, no mealtimes, no schedule, and no change performed various kinds of tasks in enclosed cham- in light.Would his diurnal cycle begin to frag- bers.Dr. E. A. Alluisi and his associates have ment? Would he der-, in short intervals like a shown that a man's efficiency can be diminished young baby? how would his health and work during a decline of temperature if the situation capacity be affected? We do not know how much forces him to handle an appreciable increment in the biological clocks inside are meshed with an information. external environment.These questions are inti- In a series of studies sponsored by the Air mately linked with man's patterns of sleep and Force, diffetent work-rest schedules have been with the possible means and consequences of tried out on selected volunteers for periods of 10 changing jleep patterns (McKenzie, et al., 1960). days to a month (Ray, et al.,1961). What are the A number of scientists have speculated that merits of working for 4 hours and then resting for sleepas we indulge in itmay be a habit and 2 hours? What ratio of work and rest permits a that the circadian temperature rhythm, with the man to be most productive over a period of time? many metabolic systems implied, could be altered Such questions are difficult to answer and may by training in infancy. A lifelong habit, like depend in part upon the nature of the job.In one sleeping 8 hours each night, has a profound physi- study a group of highly motivated cadets was cal meaning, for it becot imbedded in the orga- cooped up in a small crew compartment for 15 days, nization of the central nervous system, in the bio- with taxing jobs to do, such as picking out radar chemical timing of the body, and the word "habit" "target" signals from a noisy screen.The special should not imply that this is a pattern that can attribute of these tasks was that they were entirely be changed easily, if at all.However profound dependent upon the individual whereas other simi- its effects, there is still evidence that training plays lar confinement studies placed einphasis upon a greater role in human behavior than it does in group cooperation (Paw.ey, et A, 1061).As the experimenters varied the task requirements and lower animals. There are now studies underway, schedules of work and shell, they observed that a of humans and of animals, that may elucidate the highly motivated young cadet could work a role of habit in our sleep patterns and circadian 16-hour day (ea duty for 4 hours and off deity for rhythm. 2 honer) more easily than a lighter day (of 4 An initial survey of some 600 people was under- hours duty and 4 hours rest), but only under some taken by the Gainesville, Fla., laboratory directed conditions. Surely, for the purposes of a sensitive by Dr. Wilse 13. Webb.Intensive questionnaires and costly mission like a space flight, the best were issued to men, women, and children of dif- 13 7 ferent ages in the hope of amassing some gross to Honolulu to direct an after-dinner meeting. statistics about the role of trairing, such as the As he speaks at what is 8 p.m. for the Hawaiians, possibility that family sleep patterns are consistent it is 1 a.m. New York time, and oy the time the among family members. Do early-rising parents question period is over his weary body decrees that train their children to be early risers throughout it is 3 a.m., however early the clocks read in Hono- lifel Another approach being considered in sev- lulu.Individuals react very differently to a life eral laboratories is that of forcing unusual sleep in which such time-shifts are frequent, and there and waking schedules upon infant animals.If is no saying what impact such a schedule may early training were a large factor, it might be pos- have upon their health and performance. sible to alter the circadian rhythm in animals and, For many practical purposesmedicine, indus- perhaps, man.This might be convenient for man try, and perhaps particularly preventive medi- in the coming decades as artificial light, rapid cinea further investigation of the circadian travel, and unusual tasks alter the routine that rhytlun andits relationship with the environ- was once bounded by natural day and night. ment will be extremely useful.Further explora- Light and darkness, distance and time have con- tions should reveal something about the nature verged for modern man, and especially today indi- of the subcycles that are reflected in small fluctua- viduals could benefit from a greater sensitivity to tions in body temperature, and perhaps determine their own daily rhythms and an understanding of the fluctuations that people report in their abilities their relation to performance.Nobody doubts to concentrate, the waxing and waning of atten- that there is really a difference between the early tion, fluctuations of about 90-120 minutes that ap- r'ser, the so-called lark, and the night owl stereo- pear to take place throughout the day and night. type.Yet, recognizing the great range in sleep- One cannot say that the circadian rhythm is waking preferences, we still fail to concede that the reason that man sleeps for long periods, usually tiey are of much importance. The rigidity or at night, or that it is totally inelastic, but there flexibility of a person's sleep habits may be a re- is strong evidence that it is related to our patterns silt of early training, for instance, and informa- of sleep and that it is composed of subcycles. The tion on this point alone could be valuable in rear- study of biological rhythms in man promises to ing future generations.However, unless a person yield information of practical and medical value, is stricken with an illness like encephalitis, his cir- perhaps enabling clinicians to utilize optimum eadian rhythm remains, and his body temperature timing as part of treatment.If subcycles of the will rise and fall on a 21-hour schedule.It is not daily rhythm influence our waxing and waning of even easy to shift the phase of this cycle very wokirg attention and mood, we may learn how repidly, a i axis for the complaints of some trav- they bear on waking activity through the study elers.These days it is not uncommon for a busi- of sleepfor a night of sleep itself consists of ness executive to leave his office shortly before recurrent cycles of brain activity and physiological noon, for instance, and fly as far from New York change. 14

e The day gan fallen and the derke night That reveth bestes from Mr besinesse, Beref te me my book for lakke of light, And to my bede 1 gan me for to dresse ... Chaucer

Chapter IL A Night of Sleep Each night at an accustomed time people begin The bedside observer cannot easily detect the signs to set the stage for sleep with small rituals that of shifts within, for the place to watch a night of lead to bed and darkness. A dusk of consciousness sleep is not in the bedroombut in the recordings will fall like a curtain on the day and soon, from oflaboratorypolygraphs, theelectroenceph- outside, the body will seem still but for a shallow alograph,thecardiogram,myograph,and and even breathing. A twisting, a groan, flutter- thermometer. ing of eyelids and perhaps muffled sounds may The Electroencephalograph occasionally break the stillness, but for 7 or S The progression of cycles (hat make up a night's hours the person seems to have departed, gone sleep have been pieced together by numerous ob- from the world into a silent. internal communion servers through nightlong vigils in sleep labora- The from which he will rise like an amnesic. tories.There are perhaps 2 dozen sleep labora- forgetting, the sense of oblivion is so nearly com- tories in the United States, in university buildings plete that it is surprising how easily people accept and hospitals. They vary somewhat in size and this suspension from life, relinquishing themselves newness, and complexity of equipment, but labora- each night with little anxiety.Primitive people, tories designed for the study of human sleep understandably enough, often looked upon sleep basically resemble each other. In the control room as a temporary death, and remnants of (heir un- the visitor will notice the fundamental polygraph certainty and fear can be found in religious litur- instruments, consolidated in the big amplifier sys- gies; one example is an Orthodox Jewish morning tem, the electroencephalograph machine, a device prayer, thanking the Lord for the return of the through which researchers can watch brain activ- soul and therefore life. Although the sleeper is ity.Small conductive electrodes, bits of metal clearly animate, his prolonged stillness scarcely pasted onto the scalp, or in some cases, needles conveys to an observer any sense of the tides implanted in the brain, transmit the natural beat of a bruin region through changes of electric Sleep, ns we now know it, is not a state of uncon- potential.Tho electroencephalograph(EEG) sciousness, an oblivion punctuated by occasional amplifies these shifts in potential, transmitting dreams. It is not, indeed, a unitary state of lying, them to magnetic tape, or driving a row of ink but a progression of rhythmic cycles representing pens on the desklike panel of (he machine. Each different phases of neural function. By watching pen, driven by a signal from a part of the brain, a person sleep, the observer cannot see that the moves up when the electric charge is negative sleeper is rising and falling on the waves of a and down when the charge becomes positive. As recurrent tide. Nor van he observe that the sleeper a continuous sheet of graph paper moves forward regularly enters long intervals so different. from on a roller, at a constant speed, under the oscillat- the rest of sleep that some scientists have called ing pens, the up-and-down pen movements are it another statea state of frenzied internal activ- traced out as wavesbrain waves.Their ampli- ity, resembling in rrany ways alert wal:efulness. tude indicates the ever shifting tumult of voltage 15 9 generated in a brain region, and their shape can Our current picture of a night's sleep is a com- indicate the speed of the electrical changes within. posite of thousands of nights anti thousands of Thus, ' glance at the inked record will tell whether volunteers, most of them young men in their twen- the potentials ia the brain are shifting in a regular, ties, generally students or professionals. \'

14 20 computer, which does the dog-work of counting How can what is happening inside the brain be waves per interval, or screening for certain volt- known by recording from its surface'? The EEG age. Each wave on the record has a certain fre- has been roughly likened to the sound of a run- quency, and the EEG spectrum consists of the dis- ning motor.One can tell a great deal about a tribution of \raves among these frequencies. The motor by its noise, comparing its sounds with per- computer can be asked to do the counting, and formance.Still without opening it up, it is not spectral analysis will describe this distribution, possible to infer the precise organization or the showing frequency changes that might be im- exact contribution of any part by simply listening. perceptible to the eye.Similarly, by assig,ning a So with the EEG. The inference that a pattern of number to each point on the wave, voltages can be brain waves taken from the scalp represents handled numerically, and related to frequency by rhythm at a site de?p within is a composite from a digital computer. The emerging figures will de- many studies.So no of these may correlate be- pict, the distribution of energy in the physical havior with the ElW; they may come from ani- sense, the power spectra.Power shifts have been mals in whom dee)ly implanted electrodes show used to map subtle changes in attention and a pro- what happens at a subcortical locus while EEG's gression of changes from alertness to sleep.Spec- are obtained front the scalp.Some come from tral density analyses have shown the changing dis- studies of normal and intact people. Others may tribution of energy as an individual shifts from come from patients about to undergo neurosur- nlertnes to drowsiness and sleep.During wake- gery, in whom implanted electrodes and scalp fulness the energy may be spread among the high electrodes give simultaneous readings during be- frequenciesthe fast wavesand as drowsiness havior and different st ates of consciousness (Chap- begins there is a gradual increase of energy among man et al.,1062). the low frequency components of the brain waves. What is being r?corded from the scalp?This Researchers are using this method to obtain a EEG picture appears to be the waxing and detailed picture of energy changes in the human waning of electrical potentials in cells of the cortex, brain (hiring waking performances and different large numbers of ct lls. 'Using microelect roles that phases of sleep.Because itis so sensitive to penetrate a single I ell, it has been shown that indi- changes of attention, this technique shows great vidual neurons tralEmit, in a rhythmic manner in promise for future use in the diagnosis of the men- discharges of pubes and pauses, and they also tally ill. process information by an independent wave proc- Phase analyses describe the relative timing of ess.Instead of b !coming neutral after it fires, trains of waves, telling which leads and which lags the cell appears to reverse its polarity, thus oscil- behind the other, and by how much. Analysis of lating between negative and positive charge.Its phase shifts has proven useful in exploring the timing may be paced by the electrochemical consti- way the brain changes during learning, and may tution of its membrane, and there arc thought. to enhance our understanding of the memory process be several ways in which the discharge rhythm is in all states of consciousness, perhaps revealing influenced.It may be influenced, for instance, by why memory of sleep is so notably poor (Arley its nonneural envelope, the glial cells. Thecells and Walter, 1063). are thought. to inoculate the excitability of nerve Small EEG segments that look coherent and cells by enhancing and reducing their electrical stable to the eye have been shown to contain many resistance. Thus, tl ie EEG does not reveal directly variations, when analyzed by :( plotting of fre, the action of indiv dual brain cells, but, indicates q,,ency bandwidth against duration.Dr. Adey's shifts of potential 11 MOng masses of them. laboratory has used this "stability diagram" to When the EEG pattern is regular and synchro- discriminate between seemingly coherent inter- nous, masses of cells are shifting polarity together, vals, and has shown clear a7u1 unambiguous dif- like it crew of oars.men rowing together.This ferences between phases of sleep that were once synchrony is charm- teristic of the alpha state thought to be almost identicaland between wake- abort 8-12 cycles per second (cps), and a number fulness and REM sleep, who,e, configurations were of nenrophysiologic il studies suggest that the pace- often confused by early encephalographers. maker for this rhythm may lie in the thalamus. A vast proportion of our current work on sleep Synchrony is also Aniacteristic of deep, stage -I, depends upon the EEG, but what is anEEG? sleep, and indeed N.A s once an EEG synonym for

21 1 s deep sleep. The neural metronome for this corti- upon sleeping and waking patterns, encephalitis cal synchrony is not known, although it is thought has stimulated considerable research, most notably to lie deep within the brain. During waking, the perhaps, aft?,r the epidemic that raged through cortical rhythm is generally desynchronized, and Europe afte: World War I. Today, however, animal experimentation has pointed to the reticu- clinical studies of patients are likely to be coordi- lar formation in the brain stem as an important nated with laboratory experiments upon animals, promulgator for the signals permitting arousal. and a variety of techniques are focused upon the Oddly enough, however, the irregular, low voltage, same phenomenon.In this fashion, the behavior, rapidly charging brain waves that characterize the brain waves, and the possible brain centers for waking are seenin very similar formduring activity are slowly matched with surface re- sleep. The polls portion of the reticular activating cordings. system prominent in waking has been shown to be The process of inference and cross-correlating important during REM sleepthat curious state of many kinds of data is :nethodical and slow, but of outward oblivion in which a parson or animal the results have an almost magical quality, for like is hard to awaken, yet shows cortical rhythms that reading the Bible from the head of a pin, rt.re. resemble those of waking. searcher can look at a few squiggles, lasting no The puzzle is just beginning to be unrivelled. more than 5 thousandths of a second, and see how a What minute changes in the rhythms emanating signal travels through different brain areas and from controlling centers; what shifts of command something ahout how the brain is processing it. and organization account for these different states Whenever a sensory signal occurs, a light, sound, of consciousness and different EEG patterns? touch, etc., the brain reactr., and its response ap- Many scientists have postulated that our states of pears in a transient, visna!ly indistinct pattern on consciousness swing in the balance between that of the EEG. Ilowever, if the signal is repeated and the duininant activating system and a hypnogenic the EEG response patterns are superimposed upon system, a neural network that produces sleep when one another and averaged, random variations in the it is excited.These shifts occur within the core EEG pat tern known as "nc ise" will fall away, leav- of the brain, and emanate to the cortex through Eng a clear picture. This averaging technique has an enormous and complex system of nerve fibers permitted us to penetrate the sleeping brain that connect the cortex with the deep snbcortical Ihrough surface electrodes, because the latency, reaches within. duration, amplitude, and direction of the EEG re- In our attempts to solve the puzzle of the origins sponse can be measured and will yield information of EEG patterns, the sources of the illythns of 11,010 the slate of the broil they \vette taken from. consciousness, we have relied heavily on animal This technique has been used by Dr. Burton S. studies, with a few ex':eptions.However, in the Rosner and his colleagues on normal volunteers course of evolution, mammalian brains have (Rosner et al., 1963; Goff et al., 196:2). A signal changed in structure and distribution of functions. was repented in waking, and throughout the stages Recent si tidies have underscored the difference be- of sleep, addayg to data from other laboratories, tween lower nanirrials and man. One exploration and further elucidating the functional di Ilereilces sag.gests that the distribution of sleep phases in that seem to ..ypif our many states of ccnscious- chimpanzees and man may he regulated by the ne:4s. Many people have shown that the brain amygdala, farforward in the temporal lobes, emits a smiler response to incominr- sensory ivoller than in more basal regions. EEG rhythms, during waking and dreaming t:n during not sc.,en in lower animals during sleep, have been deep sleep.Yet the deeply sleeping person does spot red front 'he amygdala of the chimpanzee ;in(' not seem to be, disturbed by his breath on thepil- man (Adey et al., 1963 ; Rhodes et al., 1965). low, sounds, or touches, despite the fact that his Human studies are therefore. important, and brain shows a large. response.Perhaps his oblivi- fortunately modern techniques have made brain uusnes.s can lar m.lained, for sensory stimuli must probes increasingly safe and productive of rele- be integrated and processed within the brain be- vant information.Many clues to ties lo-at resi- fore they become felt.They may be received but dence of certain EEG configurations. have come not felt, unless they are integrated.If a brain from soulies of pathological symptoms, and from wave response is divided for the analysis of its autopsy.Because of its variety of strange eifects parts it seems that the sensory recept ok7cArs

16 22 first, but there is an ensuing pattern that is thought These have been correlated with the scalp EEG to represent activity at a higher station in the portrait, showing that there are cyclical changes brain.This comes very late in deep sleep, and in nervous activity sweeping through the cortex. with high amplitude.Hence sensory iuflow may Tiresrepresent changes in ment ation, conscious- show a. greater response from the specific sensory ness.Data from many sources, from deep brain fibers in sleep than in waking, yet there is almost studies,anatomicalstudies,andpreoperative no perception, for something has changed in the probes in human patientshave begun to show us integrating process.Some people believe that how to interpret the surface EEGs to understand this shift in the mode of action occurs in the the organizational changes within the brain, the diffuse projection system and its thalamic con- shift. of function and activity that appear as the nections between the cortex and the core, and strik ng patterns of nightly sleep.At the same further experiments are being designed to test time, computer techniques of EEG analysis are ef- this hy,:)othesis. fedi, ely making the EEG a far more sensitive and Summary infar mative indicator of brain activity. A great num' er of sleep studies are clarifying the normal While the examples cited here will be pursued pietu...-e of nightly sleep.It now seems likely that more fully in other sections, they may illustrate the EEG of sleep may become a useful diagnostic, hcw many levels of sleep research are converging an in:trim-tent that can point to specific loci of dis- to produce insight into the function of the brain, order, suggesting something of the mechanism of creating tools of great diagnostic value. The study of a night's sleep may entail, at the gross level, an al normality rather than simply indicating a methodical observation.By watching a sleeping devia ion from the normal pattern. New methods person i hroughout the r for instance, there are of analyzing EEG data, supported by a variety of evident physiological changes.There are clusters data, may therefore be able to take us deep within of muscle twitches, rapid eye movements, inter. the b ain so that we can see, with surface elec- vals off tillness, periods of body movement, periods trodu, activity in regions that in past years re- of even breathing, and times of uneven breathing. quire< neurosurgery for exploration.

17 And touching this point, Phisitian,s way consider; whether sleep be so necessarie that our life must needs depend of it; for we fiade that Perseus King of Macedon, prisoner at Rome, being kept from sleep was made to die; but Pliny aleageth that sonze have lived along time without sleep at all. Montaigne One sort of treatment used for those accused of witchcraft was the "tortma insomniae." Of all things in brain disease, calm and regular sleep is most beneficial; yet, under this practise, these half- crazed creatures veers prevented night after night and day after day, from sleeping or even resting.In this way temporary delusion became chronic insanity, mild rases became violent, torture and death ensued . . Andrew Dickson White

Chapter III.Sleep Deprivation Man, often in laudable arrogance accompanied We have all been exposed to anecdotal "proofs" by blinding ignorance, has always attempted to ex- that certain people can manage well without ceed the limits of his own physical nature.The sleeplong vigils of sleepless performance by obvious needshunger, thirst, respirationhave medical interns, the so-called eharrette or 3-day been accorded respect as essentials to survival. drafting binge of the architect, a spate of remark- The very word "starvation" has its roots in the able incidents retold after World War II, famous Old 'English word "sterve" (to lie); and the con- "wakatltons" endured by disc jockeys, and last nection between lac;: of food and death has leen year an 11-day stint of sleeplessness by a 17-year- plain throughout the world's history.Sleep has old high school st ndent in San Diego.Despite the been a different issue without the status ofa drive, lack of sleep the architects drafted winning plans, although sleep deprivation has long been usedas the interns treated the sick, the disc jockeys gave torture.Befoie we can answer why we sleep, or their usual performances, soldiers won battles how ranch sleep we need, modern civilization ap- and after a night's sleep, we are told, they were pears to be racing to eliminate sleep.This fresh as ever.Studies performed at the Walter heady prospect, for, if successful, it would add Reed Army Institute of Research, lergely by Dr, about 20 productive ymrs to the lifetime of the Ilarold L. Williams and his associates, have told a average man.Nevertheless Cue question remains: discouraging story about a person'3 performance must we sleep?Is sleep an integral part of our during prolonged wakefulness.Several of the (organic rhythms. our metabolism?Ona useful famons walzalloon, were, a t least lit part, studied by procedure for e eploring body needs is to depriv----- scientists. and these too offer some disheartening take away sleep and see what happens,In the information about the psychological etTects of go- 1950's, following World War II, a large number ing without sleep for long periods, as well as rais- of volunteers underwent periods of sleep starta- ing questions about aftereffects.One disc jockey, lion in lal)orntories where they were measured for with a record of some mental instability, went 7 physiological and chemical changes, their ability days without sleep, endured persistent symptoms to perform tasks, and where their psychological even after test, and ended in a mental hospital, changes were under continuous scrutiny.Anyane although in stable yomig high school strident ap who seriously thinks of eliminatingor drast parently recovered from a much longer stint with reducing his sleep should, examine this :iterallore. no noticeable aftereffects 18 24 The mental symptoms of prolonged sleeplessness ened by the tension of publicity and public con- seem to occur slowly, in a somewhat predictable ditions, some of ilie ordeals of PetTripp may fashion, mounting, as the time goes on, sometimes indicate the kind of mental symptoms that can be- into very dramatic proportions. At Walter Reed leaguer the severely sleep starved. and elsewhere one of the most misistent observa- Almost from the first, the desire to sleep was tions was the pr ,ressive unevenness of mental so strong that Tripp was fighting to keep him- functioning, lapses in attention, growing fatigue, self awake.After little more than 2 days and 2 weariness, and a tendency to withdraw from the rights he began to have visual illusions; for ex- outside world.People began to make fewer and ample, he reported finding cobwebs in his shoes. fewer unnecessary movements, F,nd showed some By about 100 hours the simple daily tests that re- confusion between their own thoughts and external quired only minimal mental agility and attention events.Certain bodily sensations began to de- were a torture for him. He was having trouble velop. A tightness around the head gave the im- remembering things, and his visual irusions were pression that a hat was being worn. Manj. com- perturbing: ho saw the tweed suit of one of the plained that their eyes burned or itched and their scientists as a suit of furry worms.After 120 ision was blurred, after 30-60 hours of sleeplesshours he went across the street to a room in the ness people had difficulty with depth perception. Hotel Astor, where he periodically washed and Small objects seemed to dart out of place, and changed clothes. He opened a bureau drawer and chairs changed apparent size.Commonly, lights dashed art into the hall for help.The drawer, as seemed to wea.r a halo of fog.Even the floor ho had seen it, was ablaze.Perhaps in an effort to seemed to undulate. By 90 hours, some people explain this and other visions to himself he tlecided developed vivid hallucinations.One volunteer, that the doctors had set the illusory fire, delib- for instance, called for help in washing the cob- erately, to test him and frighten him. About this wtbs from his face and hands.Brief dreams time he developed a habit of staring at the wall would intrude and become confused with reality, clock in the Times Square booth. As lie later ex- and people found their time sense distorted. plained, tl 3 face of the clock bore the fete of an These symptoms, along with changes of mood and actor friend, and he had begun to wonder whether deteriorationinperformance, were disturbing he were Peter Tripp, or the friend whose face he enough, and were recorded in detail in the defini- saw in the clock.The daily tests were almost un- tive Walter Poed studies that did not extend the endurable for Tripp and those who were studying sleep starvation beyond 98 hours (Williams, Lu- him."lie looked liked a blind animal trying to bin, and Goodnow).If the sleep-lossis pro- feel his way through a maze." A simple algebraic tracted beyond 100 or 200 hours, however, it ap- formula that he had earlier solved with ease now pears that the symptoms intensify and begin to required such superhuman effort that Tripp broke resemble psychosis. The fifth day has seemed to down, frightened at his inability to solve the prob- be a turning point in a number of cases observed lem,fighting to perform.Scientists saw the (West et al., 1962). spectacle of a suave New York radio entertainer Temporary Psychotic trying vainlytofindhis way throughthe In January, 1959, the largely Unaware public alphabet. saw before its very eyes the kind of temporary By 170 ]:ours the agony had become almost un- psychosis that can be induced with sleep starva- bearable to watch.At times Tripp was no longer tion.Under thesupervisionof doctors and sure ho was hiniself, and frequently tried to gain scientists, Peter Tripp, a 32-yearold disc jockey, proof of his identity.Although he behaved as if undertook- to stay awake for 200 hours in a Times he were awake, his brain wave patterns resembled Square booth for the benefit of the March of those of sleep.In his psychotic delusions he was Dimes. Throughout this marathon of over 8 days, convinced that the doctors were in a conspiracy Tripp was given medical and neurological ex- against him to send him to jail.On the last morn- aminations, tests of perforinance, psychological ing of his wakatlion, Tripp was examined by Dr. tests, and NV fls closely attended by Drs. Harold L. Harold Wolff of Cornell. The late Dr. WoltT had Ardie Louis iTolyonWest, a somewhat archaic manner of dress, and to Tripp Harold Wol IT, William C. Dement, and others. he must have appeared funebrial.Tripp un- Although his experience was undoubtedly worn- dressed, as requested, and lay down on the tahle 25 19 for medical examination, but as he gazed up at the stimulants, he stayed awake for 261 hours.Drs. doctor he came to the gruesome decision that the L. C. Johnson, W. C. Dement, and J. J. l'oss were man was actually an uncle/taker, about to bury on hand for observation and medical examination. him alive.With this grim insight, Tripp leapt Here there was quite a contrast to Tripp's waka- for the door, and tore into the Astor ball with thon. several doctors in pursuit.At the end of the 200 Randy Gardner did, indeed, show progressive sleeplesshours,nightmare hallucinationand changes with sleep loss. By the fourth day he be- reality had merged, and he felt he was the victim came irritable, suffered lapses of memory and diffi- of a sadistic conspiracy among the doctors. culty in concentrating. He saw fog around street With some persuasion. Tripp managed to make lights, felt the band of pressure of an illusory a final appearance in the glass-windowed booth hat, and imagined a street sign to be a person. By in Times Square, and after his broadcast he went the ninth day he seemed to think in a fragmented to sloe? for 13 hours. Although the record of his manner and often did not finish sentences, some- ordeal covers hundreds of pages, the few instances times experiencing transient reveries.His eyes cited bere may give some indication of the ex- bothered him, and he becume unsmiling and ex- trc-ne distortions, mental agonies, and delusions pressionless. At one point, about the fourth day, he suffered, especially during his last 100 hours he bad imagined himself a great Negro football of sleeplessness. When he awakened after his first player. He (lid not, however, show extreme symp- long sleep the terrors, hallucinati ms, and mental toms, and at the end of 11 days, he slept for over 11 deterioration had vanished.He no longer in- hours, and rebounded into a healthy and cheerful habited. an unstable visual -world where objects ap- mood. Dui ing the last few days of his vigil, how- peared to change size, where a doctor's tie would ever, he had shown definite neurological %:hanges. jump out of place, and where it was a superhuman His vision was blurred, and his right eye was mak- effort to solve a simple problem or remember an ing involuntary sidewise movements. Whether his anecdote. In 13 hours of sleep the nightmare ex- eyes were (pen or closed, his alpha rhythm was istence .tnad been left behind, although for 3 months markedly reduced, and he showed waves charac- afterward Tripp suffered.a mild depression. teristic of sleep. The usual alpha wave enhance- Quite aside from the quick apparent recovery from ment to external stimuli was no longer present. extreme symptoms, there had been two extremely Physiological measures indicated that during de- striking patterns throughout the ordeal, periodici- privation tl:e basal autonomic pattern was one of t ies that suggested that Tr:pp's times of strength activation, but also that there was less responsive- and mements of worst symptoms followed some ness to outs.de stimuli.For example, during dep- inner cycles.Throughout the ordeal Tripp had rivationtherewasmarkedvasoconstriction. been able to organize and perform his di ily broad- Randy's heart rate rose above normal.His skin cast.Temperature readings showed that he was temperature and electrical skin resistank'e were at his peak at the broadcast time, the point of his very low.As time vent on these indices, which highest daily temperature.Ills bursts of hallu- usually show changes in response to external cination and strange behaviors, on the other hand, events, became less and less responsive.When seemed ro occur in 00-120 minute intervals, at times Randy finally went to sleep, however, all of these when he might normally have been dreaming. At measures showed responses to external stimuli, the time this periodicity suggested apossible save only the galvanic skin response. On the first physiological link between the mechanisms of night of sleep after his vigil, his EEG showed a dreaming, psychotic symptoms, and hallucination. different pattern that. on successive nights.It In retrospect some of the observers feel that the contained a concentration of slow wave (stage 4) most impressive changes were those that followed and stage 1 llEM. Ten days a ftcr the vigil, Randy the (Hurt- a! cycle, was clear of all symptoms except for slight diffi- The Role of Age culty with memory and involuntary eye movements Six years ago, wlien Peter Tripp began his (nystognms ,',(Johnson, et al., 1065; Ross 1001). marathon of ivakefulness, he was 32 years old. These t wl very different individual reactions Last year, a 17-year-old MO school student set out illustrate several important aspects of sleep loss, to break the record, and ir. the quiet atmosphere that have been corroborated in other stmlies. of his home, without the help of coffee or other Randy Gal miner, by psychiatric measures, with. 20 26 stood his long vigil with greater ease and less effect to see them maintain position day after day. Some than any of the people who had so far been lasted 27 days before they fell.This feat of recorded beyond 120 hours of sleep loss. Ws own wakefulness raised some interesting questions. home and the attendance of his own family physi- How had the young rats managed to stay awake, cian provided surroundings that were less exac- continuously moving for 27 days? The experi- erbating than those of Peter Tripp or others, even menters speculated from other data that these on shorter vigils in the laboratory. He took no flexible young animals had not yet formed rigid stimulants.But perhaps equally if not more im- sleep patterns and were able to sneak short naps of portant, were his youth and his general stability. a few seconds. The only way to corroborate this A person's reaction to prolonged wakefulness hunch was to obtain continuous EEG readings would appear to be congruent with his personality while they were astride the water wheel, and see patterns and what might loosely be called stability. if characteristic brain waves of sleep appeared in From interviews end psychiatric tests of 74 army the record.It was technically impossible to ob- volunteers inWiller Reed studies, researchers tain EEGs from rats 63 days old, for there was found they could predict reasonably well which then no way of implanting electrodes into the individual would find the experience most diffi- small and delicate brain. The repeated experi- cult and would report hallucinatory events (Morris ment had to be conducted with older rats, whose and Singer, 1961).Some years ago, at McGill brains could be implanted with tiny electrodes. University, six chronic schizophrenic patients were The older rats were about 200 days old. kept awake for 100 hours. As sleep loss continued When these adults were placed upon the water these patients began to show acute symptoms that wheel, however, they had no staying power. They had not been seen for several years among them, fell off in 3 to 4 days.The experimenters immedi- auditory hallucinations (Koranyi and Lehman, ately began testing rats of intermediate ages on the MO). The extent of a person's suffering under wheel.The animal's age was directly correlated protracted sleep ltss would seem to depend upon with the number of days he would last upon the what we term mental health, and the six publicly wheel (Webb, 1962).In order to gain some in- recorded wakathor s that have been undergone in sight into this differential staying power, the ex- recent years seem to highlight the point that symp- perimenters developed techniques for implanting toms ucur sooner, and with greater intensity, in young animals. They have recently found that unstable inedvidua's. There is also some evidence, the young animals manage to spend a surprising however, that age maybe an important factor. amount of their time asleep.By running to one Randy Gardner, who set the record fora sleep- edge of the turning wheel they can then ride with less vigil, was the :.oungest person to attempt this stint.Further evidence that young creatures may it, catching a nap of 10-15 seconds before they withstand sleep lets for longer periods than older must quickly move to avoid falling.By this ones has come fr.:in the laboratory of Wilso B. maneuver, the experimenters have estimated the Webb at the University of Florida.The finding animals may spend a third of their time on the was serendipitous because it arose from a rat study wheel asleep.They are evidently very tired by that was not designed to explore this point.Orig- the time they leave the wheel; nevertheless, the inally, the experimenters had designed a contin- young rats manage to spend long periods atop the uously rotating moil wheel, two-thirds submerge,t wheel in this fashion, whereas the older rats can- in water, in order to keep rats alert without caus- not.It does seem, at present, that age bears sonic ing muscuular exlmstion so that they would fall relation to the ability to withstand sleep /oss, and asleep instantly wl en placed in a recording cage. this capacity may be associated with the ability to Rats avoid cold wale r, and the wheel moved slowly snatch brief naps, although the reasons may be enough so that the;' would not fan in if they kept multiple and related to metabolism, especially in awake and moved very slightly.Because the. orig- rodents, and muscular vitality as well as "habits" inal wheel was small, it could not carry a fully of the nervous system. grown animal, and so the firstexperimental animals were tery young, about 63 days old. Physiological Changes The experimenters expected the creatures to last Although next to nothing is known about the atop the Scheel for ,everal days, but were slit prised psychological changes that may he occurring in

2`7 21 animals as they are deprived of sleep some changes At present we have no way of determining what have been observed (Webb, 1962; Kleitman, 1963). changes may leave a subtle, lifelong >ffect, perhaps It is largely from animals that we have learned even a chain reaction, enhancing disease, perhaps about the damages that sleep loss may induce in shortening the life span.Animal and human brain tissue.From histological studies of animals studies have indicated some of the physiological experimenters infer that there may be certain changes that occur when sleep is prevented for changes in human brain tissue during sleep loss. long intervals. How these may vary with age is not known. The Abnormal amounts of nitrogen and potassium published case histories suggest that many of them have been found in the blood and urine of sleep- must be reversible, and the recent, study of Randy deprivedanimals. Glandular and hormonal Gardner suggests that youth may be an advantage changes have been ()User -ed as well, and it is inter- inrecovering from sleeploss.It should be esting that experimenters report irritability and repeated, however, that subtle aftereffects, per- belligerence in sleep-starved animals, lik3 that of haps not noticeable to Randy or to a casual on- sleep-starved people. looker, persisted for 10 days, and perhaps months Several studies suggest that the body metabolism after the vigil.Aftereffects have been difficult suffers difficulty during prolonged wakefulness, to measure and evaluate in human kings, and the and these suggest one of the ways in which normal quest on of tissue damage is unanswered at present. sleep may be regulated. The body appears to be Studies of sleep loss have been relatively few and govern3d by internal clocks, intermeshed systems recent, and the question of prolonged, perhaps of biochemical change that we call metabolism. even indefinite, aftereffects remains an unsettled One of the cycles we have come to recognize is a one.There is no way of telling whether the diurnal rhythm of rising and falling temperature severity of aftereffects may be in prop] lion to the in man.In the Walter Reed studies oral temper- pathological symptoms experienced during sleep atures were taken during a 9S-hour period of sleep stvat ion. deprivation, and it was clear that the diurnal Perhaps it is worth citing a few of the animal rhythm remained. Indeed, people felt most sleepy experiments that have shed a little light on this and tired at the time when their temperatures were question.As early as 1894 M. de Manaceine lowest. During the progressive sleep loss, in addi- demonstratedthatcerebral hemorrhages took tion, the overall body temperature declined some- place in puppies when they were kept awake to wlmt. Perhaps this was an indication of a declin- the point of death. Tissue damage in the cortex ing metabolism, a progressive inability to produce and frontal lobes was reported Daddi in adult energy (Williams, Lubin and Goodnow). dogskeptawake,fatally,from 9-17days. Energy Metabolism Nathaniel Kleilman kept puppies awake for 4-(3 The awake person, however quiet, is placing days, and many died.They, too, had suffered demands upon his nervous system and his muscu- cerebral hemorrhages, and the number of red blood lature far in excess of the activities of sleep, thus cells had dropped to about half of the normal draining the energy reserves of his body. A hie- count.Other changes in neural tissue were ob- chetnicrd study of two sleep-starved volunteer- served in sleep deprived dogs by Legend re and one wa'eeful for 5 days, the other for 10 days Myron, and these we,v, shown to he reversible if suggests that biochemical mobilization of energy the animals were allowed to sleep.Sleep-deprived changes considerably after 4 or 5 days without rabbits showed cell changes in the spinal cord and sleep.This may account for the pathological brain stem, and sn, depending upon thespecies, symptons and delirium that have been observed it might seem that sonic of the clinical signs ob- after t days of sleep loss (I,nby et al., VW, 1961). served during sleep deprivation come from cell The body's transformation of food energy into a changes in the cerebral cortex and brain stem.In form useful to muscles, nerves, and all cell activi- some of the many animal experiments a single ties depends upon a single chemical.It is adeno- period of sleep restored the animal to normal after sine triphosphate, known as ATP, which seems a moderate deprivation (Kleitman, 1903).Ifow- to be the catalyst for energy release in all living ever, nobody can be sure that a long period of matter.Every cell, at any given time, has a cer- sleeplessness or the habit of skimping on sleep for tain proportion of this nucleotide with its three mcmths or years will leave no permanent ill traces.. phosphoric acids As fond substances are trans-

22 28 formed into cellular energy, ATP breaks down a stressor like insulin.After stresses such as from a triphosphate into ADPadenosine di- fright or frustration, changes in hormonal output phosphate. By a process known as phosphoryla- and noradrenalin can be detected in the blood: tion ADP and adenylic acid combine to make corticosteroids that are secreted in extra quanti- more ATP, which is stored with creatine as re- ties by the pituitary adrenal glands.There has serve energy. However, during prolonged activ- been considerable speculation about what part )f ity the stored supply is used up, and new ATP the brain tells the pituitary to shift into emergency must be created. At about 4 days of sleep depriva- production.The suggestion of another biochemi- tion, the production of the three critical energy cal link in the metabolic and mental changes of substances of the body appears to run down. This sleep loss had its roots in a discovery of a brain seems to be the evidence from studies of six indi- region in humans that may take part in issuing viduals at the Lafayette Clinic (Luby et al.). the command for the extra production of stress At first, energy production seemed to increase by hormones.During the early 1960's, Dr. Arnold an emergency process of synthesizing chemicals 'Mandell and a team at UCLA found an eleva- not usually utilized.But after the fourth day, tion of corticosteroids in epileptic patients who the emergency metabolism seemed exhausted. had undergone presurgical exploration and had This was the time when the subjects showed most received gentle electrical stimulation in the amyg- striking changes in personality and performance, dala, a portion of the brain that is frequently in- experiencing the weird phenomena associated volved in temporal lobe disease.The anaygdala, with delirium. The fact that sleep returned the far forward in the brain, seemed to play some part . energy systems to normal and restored the individ- in the neural command system by which the adre- uals to normal behavior suggests that sleep may nal-pituitary glands are induced to pour hormones be essential to the body's system of energy produc- and stimulants into the blood during crisis.This tion, that it is integral to metabolic functioning. finding led to a further exploration of the chemis- These biochemical studies instigated new inter- try of stress.Using normal volunteers, under est in the relation between sleep loss and mecha- mild stress, they injected ACTH, which acts as a nisms of mental illness.Clinicians have long ob- hormonal stress and is indeed one of the pituitary served that sleep disorders, particularly insomnia, hormones. ACTH stimulated adrenal production. often precede a first attack of mental illness or an Moreover, when the blood and urine were put to acute episode in the mentally ill.During sleep chemical analysis, a new and previously unknown starvation, even the functioning adult can be substance, had appeared.This chemical wns re- swept into the unreal world of a transitory mental peatedly produced by artificial stress.It belonged illness.Although we do not know what specific to a family, the indoles, related in structure to biochemical changes activate particular neural semtonin and LSD-25.Subsequent studies were mechanisms to cause visions, distortions, and hal- to demonstrate that this indolesignal of stress locinations, we have now seen that the severe might appear in the blood even before there was symptoms appear at a time when the body's energy any elevation of stress hormones, possibly preced- metabolism has utilized emergency means to pro- ing the emergency action oflie pituitary-adrenal duce energy and may not be producing a normal glands in some instances, and possibly signifying ratio of transmitter chemicalsThe approxi- a separate biochemical system operating in stress mately 5-day turning point is a point of extremely (Mandell et al., 19t;:3). low ebb andfatigue.Studies report many Studios of normal people under food or sleep changes long before that, inattention, changes in deprivationfollowed. Win nvolunteerswent rnocxl, visual and tactile illusions.Even after wit bout food for 2 days there %vas almost no signi f- hours' sleep loss has produced noticeable icant rise in stress hormones, but the indole ap- etTects. peared.After only 48 hours of sleep deprivation Another possible link in the chain of metabolic the indole was detectable, silt:lough stress hor- events nas only recently been discovered by scien- mones increasedafter 24 hoots.Should this tists who have been exploring ihe body's reaction stress-responsive indole have psycitotornimetie ef- to stress.During sleep loss, as the Izdayette fects like LSD, and increase during pronvFsive group has indicated, the energy metabolism first sleep loss, one might expect that it plays a role in acts on An emergency basis as if sleep loss were the behavorial changes observed (Mandell, et al., (1 la 23 inpress).This new evidence of biochemical Psychological Changes change, during early sleep loss, again suggests a The psychological changes observed i;t sleep- link between sleep, metabolic processes, and symp- starved people surely prompt questions about the toms of mental illness.Because it is so vague, the relation between fatigue and moral behavior. No word stress is usually avoided in describing sleep studies have been designed specifically to probe loss and other events.Looked at as a chemical this point, although, indeed, sleep starvation ap- signal of stress, in some colloquial sense, however, pears to produce some behaviors that might be the appearance of this indole suggests that sleep considered a weakening of moral character. Long loss, like other stressing events, causes biochemical before the appearance of gross psychotic symp- reactions that may be clues to the etiology of men- toms, for instance, an individual experiences sheer tal illness. fatigue and will start to economize on muscular The biochemical traces of prolonged sleepless- and intellectual effort to shift from one activity ness have been explored only recently in human to another when left to his own devices and in- beings. The weakening impact of steep lossthe dulge in listless and transitory social interactions. fact that it plduces confusion, disorientation, and (Murray et al., 1958, 1959). As one laboratory even delusionmust have been known throughout study suggested, a person may begin to take the history. The standard trick of the villainous has easy way out, choosing the strategy that demands been to deny captives sleep (West, 1957). This is the least of him. Although this indication of lazi- still a tool of the police in extorting confessions, ness says nothing hbout moral decisions under and an inherent part of some military interroga- fatigue, it suggests that the study of sleep loss tions.Because protracted sleep loss can produce may have many social implications. The world psychotic symptoms that are erased by a period might, indeed, be different if everyone got 9 hours of sleep, it has been said to break the will without sleep, and if key decisionmakers were not among leaving scars, providing one of the cheapest, most the least rested members of society. Such specula- traceless end humiliating forms of torture. Ap- tions must go unexplored for the moment, but parently, it has been one of the more successful there is a large body of information of great social techniques of Communist interrogators, and the relevance, in the thorough behavioral studies con- subjective agonies of the transition to exhausted ducted in the laboratory of ITaro/d L. Williams unreality are well known as described by Arthur at Walter Reed. Koestler in "Darkness at Noon."Presumably Sleep Loss and Performance sleep-loss psychosis occurred among some of the These studies begin to answer some very prac- U.S. fliers intheKorean conflict :people who tical questions about man's ability to perform signed confessions of germ warfare and could not, while deprived of sleep, at the same time exploring later, account for their on n behavior. The leeched some of our most basic questionswhy we sleep, and hollow-eyed suspicious stare that has char- and what happens when we don't.Under the re- acterized the faces of many sleep-deprived volun- current exigencies of combat or work deadlines teers has been seen by everybody in the trial photo- people are not ordinarily deprived of sleep for graphs of the tragic Cardinal Mindszenty, who 10 days at a stretch. But 3, even 4 day vigils have presumably suffered continued sleep loss and inter- occurred in battle, among seamen, and profes- rogation before he publicly confessed to being a sionals.At Walter Reed, during 1950 and 1957, spy. The fact that protracted sleep loss can induce a first group a volunteers was kept awake for 43 effects like those of a temporary psychosisdis- days (72 hours) while a second group attempted orientation of lime. place, person, and identity: 4 days of unremitting wakefulness. The point of confusion. inattention, visual illusions, hallucina- the studies was not to Nish the men to the limit tion, and delusional thinking- -has provided a tool and examine psychological abnormalities, but to for exploring mental illness experimentally from examine thoroughly their abiltiy to perform cer- many sides.During the last ]0 years many new tain tasks.The volunteers, all of them young tools have been added to the scientist's armamen- :rimy men, lived out their experimental period in tarium, so that behavior, EEG events, physio- a well-equipped hospital ward, attended by nurses logical changes, and metabolic changes can be and corpsmen, and were subjected to the same bat- correlated. tery of tests at the same hour each day. The staff

24 3,0 maintained a 24-hour watch, keeping drowsy vol- to add rapidly, yet accurately, the subjects man- unteers awake; food, coffee, and recreational facil- aged to do arithmetic correctly by finishir g fewer ities were amply provided at all times. This was problems. They could not sustain accuracy and an unharrassing setting und permitted companion- speed. A person who could set his own pace per- ship and some esprit. As the sleep loss progressed formed far better than he did when paced by the men reported increasing irritation with their somebody else. eyes and vision, a few suffering illusions such as When playing a communications game in which the apparent vision of steam rising from the floor, one volunteer issued orders and another executed cobwebs, or hair in milk.Intrusive thoughts, or them, the person issuing the orders made fewer fantasies, the hatband illusion, and time distortion errors than the subject following them. As sleep occurred. From outside one might have said that loss progressed, however, both made more errors, their mental processes were slowing down. They and by 70 hours into their vigil they doubled the would lose their train of thought, make mistakes number of errors they had !node in a rested state in speech, sometimes meandering off into a fantasy. (Schein, 195'). As they filled the long hours between tests, the A wealth of eminently practical information young men quickly shifted from reading and play- emerged from the Walter Reed studies, and al- ing complic.ated games to desultory conversation, though this WP.S not their most important contri- avoiding intellectual effort (Williams, Lubin and bution, it is worth reciting some of the results. In Goodnow). the initial studies, monotony seemed to ivorsen the Most people realize that it is ads isable to avoid performance of the sleep-starved volunteers, yet driving a car, flying a plane, or performing cther upon further testing it appeared that monotonous manipulations that require split-second reactions jobs such as t racking an uncertain signal generated if they have been deprived of sleep.Safety man- more errors than highly redundant yet tediom uals sometimes say that reaction time slows down tasks. Accuracy of scanning could be maintained with fatigue. After about 30 hours, as the Walter by sacrificing speed.Performance could be im- Reed subjects showed, reaction time became very proved if the person received feedback, telling him uneven. A man might take three times longer than the results of his moves. Incentive also improved normal, on the average; to respond to a signal, but performance. So did a challenging and competi- at times he would react quite as rapidly as he had tive task.R. T. Wilkinson, of Cambridge, Eng- before sleep loss.Sometimes, however, he would land, tested a ganm that simulates a naval battle, take a very long time tc react.lie was not sinply and found that steep-starved subjects performed and steadily slowing down like an unwound clock well desp;e fatigue. On the other hand, progres- as sleep loss went on, but he seemed to be missing sive sleep took its toll \ hen a person had to signals altogether, grossing progressively more un- cope rapidly vith added increments of informa- even cn reaction time tasks. The net might tion; for instance, a volunteer could rapidly soft have looked l ike a radical slowing of response t ;me. cards into 4 categories under progressive sleep loss, In fact, the volunteers were progressively experi- but could not speedily sort them into 10 categories encing more and more lapses of attention in which (Wilkinson, 10O1).With progressive sleep loss they utterly failed te get the signal. the volunteers became'ess efficient at optional Reaction time tests generally require a subject. tasks. When playing ago nst the standard slot ma- to press a button or perform a manipulat ion sv)eti- ci for instance, the normally rested volunteer ever a certain sie-nal occurs, but the :Adeo Loa no t tied to vary his moves so as to "heat" the machine. control over the pacing of the signals.As the lIowever, early in his vigil the same man would Walter Reed team began to (ii,tingnisli l'etweert adopt a rigid and predictable, strategy, no longer tasks flint suffered mom during sleep loss and try' ag to keep in mind past plays that might reveal those that seemed resistaut, it became clear that rho machine's program. It was as if he no longer sleep-starved people did far better sheet they were eared anal Nrere alternating his choices in the man- allowed to set the pace theinsels-es.They could, ner that cod the least nualtal etTort. for instance, maintain accuracy in Folvi:ig prob- Performance was not the Fame at all limes of lems.Alosved to take ns nmeh time they day and night, but tendr,41 to show the most de- wanted, the volunteers could add pairs of numbers t eriora lion in the early morning hours during the accurately (Loveland and Williams).If prcsscd low point of the doily temperature cycle, improv-

31 23 ing during the next day, afternoon and evening. person seemed to have experienced a brief seizure This daily temperature cycle became slightly ex- of sleep, which has long been referred to as a aggerated during sleep loss, and the volunteers microslep (Liberson, 1945). Thus a person, set- felt most fatigued during their periods of lowest ting his own pace, might slowly but accurately temperatui a Symptoms, lapses of attention, in- solve a problem or read a paragraphbut if the trusive thoughts, illusions, skin sensations, and text were read to him, a microsleep might cause dreamlike experiences also clustered roughly be- him to miss a word or phrase and thereby to mis- tween 5 and 7 a.m., when the person would ordi- understand. He might miss a number and com- narily have been sleeping. The volunteers also pute incorrectly. On a scanning task, ho might showed a different reaction to background noise miss a sig,nal on the radar screenand from an when they were sleep-starved (Wilkinson, 1963). error of omission, be led into an error of judg- Normally, a rested person will fare worse at a vigi- ment and action.3licrosleeps become more fre- lance task when there is a hissing tease in the quent as sleep lost, continues, interfering with a background, but this hissing seemed to improve person's reception of outside information. the performance of the sleep-starved. These transient lapses have not been blamed for At first glance, there is something very strange peculiar psychological effects, and a humorous bio- and inconsistent about the behavior of sleep- graphical incident in the writings of Mark Twain starved people as it has been described in the liter- suggests that microsleeps might be blamed for a ature.They can read yet find it difficult to follow host of superstitions and reported apparitions. simple orders.Peter Tripp managed to organize In his manuscript "Mental Telegraphy," Twain and conduct his daily broadcast, yet found it hard recalls watching a stranger approach his house, to perform simple tests..Volunteers might react and then vanish.Twain, convinced he had seen a swiftly to a signal in one instance, yet utterly miss bona fide apparition, hurried to the spot, and then a signal the nest time. A crucial test of sustained inside.He found the man sitting in the inside attention was used at Walter Reed and high- hall, having ring and been ushered in by the serv- lighted the nature of this seemingly strange com- ant.Not having seen this, Twain concluded that bination of incapacity and capacity among the he had been asleep or totally unconscious for about sleep-starved.This was the Continuous Per- 60 seconds, while the man rang and entered the formance Test designed by Rosvo id and Mirsky of house.If the man had gone elsewhere in the NIII (Mirsky and Kornetsky, 1964).The sub- house, instead of waiting in the front hall where jmt merely had to press a lever whenever a par- Twain could see him, Twain confessed. ". . . ticul ar ::equence of letters appeared amongA a con- thirty yoke of oxen could not have pulled the belief tinuous parade of letter:; across a screen, or when out of me that I was one of the favored ones of a sequence of sounds was heard among a continu- earth, and had seen a vision - -while wide awake." ous train of sound; or when a particular vibration Sleeping on one's feet is no myth. Where long occurred among others.As sleep loss progressed vigils are essentialas perhaps in ran industrial the subjects made more and more errors of omis- mission, a space trip, or a military operationit sion, whether the signal was visual, auditory, or seems clear that self-paced tasks, group tasks with tactile.These lapses were a key to his progres- inherent competition, and high incentive tasks aro sively uneven performance on other testsfor he to be preferred over sentry duties, surveillance, or was missing things. monitoring for sleep-starved personnel.Increas- Thar lapses in attention had been observed be- ingly frequent microsleeps, the influence of the fore, and studied by Bjerner and Liberson. The temperature cycle, and evidence for a rhythmic oc- brain wae recordings of Walter Reed volunteers currence of dreamlike intrusion in 90-120 minute soon indicated what had been happening. A sill,- intervals provide some new guidelines by which we ject, wearing electrodes, could perform a tactile or auditory vigilance task while reclining with his can now design the tasks and work schedules of eyes closed. The EEO record taken at the time of people on long and potentially sleepless duties. his lapses showed that the characteristic alpha We are only just beginning to realize that sleep re rtythm of wakefulness had slowed down. For quires the same kind of attention we normally give bile f me wins, perhaps 2-3 seconds, bursts of slow to the log;slics of food, sanitation, and other WRITS appeared, resembling those rf sleep.The essentials. 3 26 Summary immediate iffect, an alteration in the person's The study of sleep starvation to date has under- 'usual EEG pattern of sleep (Sampson. 1965; scored a number of factors worth restating.Pro- Webb and Agnew, 196i). Eight young m in in a gressively, as sleeplessness is prolonged, a person University of Florida experiment cut their sleep suffers sensory disordersillusions of visual and to 3 hours a night for 8 days. During these nights tactile sensation that may eventually develop into their sleep was not simply a miniature, a com- hallucination.Lapses of attention, microsleep in- pression of their usual nightly pattern, for they tervals become frequent.There is a tendency to spent about as much time as usual in deep stage withdraw from activity, to become disoriented in 4 sleep, at the expense of other sleep stages (Webb time, and place, and person. The extent "f the ef- and Agnew, 1965). As this study progresses, it. fect.; are influenced by many environmental fac- may reveal whether a habit of reducing sleep pro- tors, but psychological symptoms may be related duces behavioral effects, and whether there are in their intensity to the mental stability of the in- cumulative disadvantages. dividual.Age seems to be a significant factor, Surely the behavioral studies of sleep loss per- and there is some evidence that it is easier for the formed at Walter Red suggest that, however young to withstand and recover from long vigils. subtle, the effects can le socially and individually As reflected in the brain wave patterns, a charac- undesirable. Among the least mentioned is the teristic effect of sleep los; is the slowing of the intense desire to sleetin people who must, for e-aking alpha rhythm.Reduced responsiveness whatever reason, stay awake for long periods. to sensory stimuli occurs on autonomic measures, Must we sleep for tong periods, or could we although heart rate, for example, has been found train ourselves to nar ?Do we need a certain to be somewhat accelerated.Stress hormones in amount of sleep for sanity and health, or could we the blood show an elevation very early in sleep reduce sleep radically?These questions have not loss, and signs of biochemical changes occur with- been answered by experiments in sleep depriva- in 48 hours.The energy metabolism of the body tion, although some3f the studies hate been is altered, showing a severe decline at about 120 undertaken in order to determine changes in hours and coinciding with the onset of psychotic metabolism or other biochemical events that may reveal how sleep is normally controlled.For a symptoms. start they ha% 3 shown that sleep loss, and the con- Although a single night of sleep appears to tinuing activity of wakefulness, incur biochemical erase most of tho symptoms, there is no saying at changes and metabolic alterations, and these may this point what subtle traces may persist, nor how be related to the coincident pathologythe tor- these may be related to the age and usual ; ental tured and psychotic behavior that has character- state of the sleep-starved individual. Th3 effects ized most of the severely sleep-starved adults ob- of chronic sleep loss are almost unknown, and we served so far.Sleep loss induces a variety of do not now know how a habit cal reduced sleep abnormal symptoms in otherwise normal people, may influence waking performance or lifelong and it is interesting to note that sleep disorders, health. EEG studies of volunteers on schedules notably insomnia, are commonly precursors to of restricted sleep have shown that there is one acute episodes in the frontally ill.

u'1

17 Thin are the alight - skirtsf t behind By daybreak hours that onward creep, An Min, alas! the shred of sleep That wavers ,with the spirit's wind ... Dante Gabriel Rossetti Silent is the house: all are la id asleep: One alone looks out o'er the snow-wreaths deep Emily Bronte

Chapter IV. Sleep Disorders The very symbol of pence and well-being is the Insomnia silence of a darkened town asleep; it is a lonely Insomnia, whether real or imaginal v, has be- figure in a lit window who may be in trouble. come so widespread that it helps keep the drug The he: lthy, the fortunate., succumb to sleep cas- companies in business, especially in large cities tu.:ly, tiL.cepting it as naturally as breath, enjoying where tranyiilizers and sedatives are constuned lay a respite from worry, ;fief or pain, and awaken the trainload.Most adults have had difficulty refreshed.Without this nightly suspension, the falling alcep in times of trouble or worry, and wealthy are poor and the poor destitute. The in- during the fever or pain of an illness.Elderly ability to sleep, or stay awake, or a disorder in the people and depressed patients often find that they recurrent cycle of sleep can become a torment and awaken long before they wish, in the dawn or disrupt a life with appalling speed.Sleep dis- predawn hours.In its many forms, insomnia orders can alter a person's mood and behavior to probably consul 'es one of mankind's most subtle a degree that i5 often ignored, and mood, activity, tortures, but nirny pecple apparently think they and environment play their part in altering sleep. are tormented Nvith insomnia at times when they Sleep disorders are a concomitant of many mental are actually asleep. illnesses, and it1.as been said that anyone who To date few studies of insomnia ft- ve been con- visited the wards of a mental institution at night chimed in the Flyer, laboratory, One of these, pe r. before the wide use of tranquilizers stepped into a formed in the l'Au's by Dr. yv. 1,:herson, living showed that insonmiae patients alternated between most common sleep disorders are those that periods when th,ir brainwave.s showed the lare accompany aphysical or mental disease, but waves of sleep, and periods Giving patterns of there are others, elmincterized by inappropriate alertness.During the brief episode of sleep the sleep, snoll as narcolepsy, encephalitis, and certain pathotts 11)1[1(1:,11,11V, but later irIV111:! tdept, forms of epilepsy.Studies of these varions sleep presumably beeat;,o Of the rapid altornition with abnormalities have enlightened someofOl!rpeclz- alertness.Nurses, having heard the snores, would lation,; about the normal mechanisms of sleep, and insist that the patient had been sleeping soundly. have miderscored the fact that sleep is not an iso- Duriti the late it.r,u's, Dr. Artlou Shapiro, at lated event, but part of a rhythm that involves New Folk's Downstate Medical Center, ieeorded the entire iersrti, his holy chemi,t ry, leis 11111111 the nightlong of severalprofessedin- 011t1001. 11;:. behavior,hisen,otico,..,;Irahis somniacs. Several Volunteers eemplrined that environt ei;t. h,o1 rot slept NI ly 11111111 all 1/i,')J1t, !Mt thi'r 34 28 brainwavestindicated that they must have been who exec( rbates his problem by growing tense asleep, dreaming they were awake. Since that time over his stipposed inability to sleep; and its pos- a number of laboratories have seen instances of siblecauses are of great interest. A study "wakefulness" during which people were actually performed by Lawrence Monroe, which is sum- sleeping. marized ir. a later chapter, indicates some of the Perhaps the most startling confusion of sleep striking physiological and EEG differences among and wakefulness took place in the University of individual;, characterizing what has loosely been Chicago Sleep Laboratory in late 1963 when Dr. called good. and poor sleep.These seem to be cor- Allan Rechtschatfen and his associates were track- related with personality factors and health.Ac- ing the process of falling asleep.In this pilot cording to the data collected so far, it does seem study, subjects -went to sleep with their eyelids that people vary considerably in the "depth" of Japed half-open. When their EEGs indicated their sleep, and that some people may retain the first stages of sleep, a lighted object was held greater contact with the outside world and sub- before them. A few seconds later they were awak- jectively feel awake at times when they think they ened and asked about their thoughts.In a are in control of their dreantlikr, experiences t-md. sequence of many such awakenings one subject thoughts. never saw the illuminated comb or cap before his People hospitalized for the treatment of depres- eyes, but persistently asserted that he had been sive illnesses, have shown generally abnormal alert awl wide awakethinking.His thoughts sleep pasterns as judged by EEG recordings were fragmentary images, often resembling brief (Gresham et al., 1905). Indeed, EEG records of d rea sleep have been seen, so abnormal as to be hard An interesting and detailed study of the drowsy to imerpret by the usual EEG guidelines, and state has been performed by Drs. W. T. and Cath- these were the sleep records of persons with severe ryn W. Liberson of the Stritch School of Medi- classic depressions (Hawkins et el., 1965). cine, Hines, Ill. They, too, have found the distinct An early study of depressed patients with sub- EEG patterns of drowsiness in people who denied jective insomnia indicated t hat these people took being drowsy and claimed they were just think- longer to fall asleep than their normal counter- ing. The eyes began to roll slowly during, the first parts, and moreover, spent twice as lunch time in onset of drowsiness, increasing for sonic seconds, a light phase of sleep from which people usually and then diminishing and disappearing as sleep report dreaming or thinking (Diaz-Guerrero et spindles appeared on the EEG. As the drowsy al., 1916).Nurses in hospitals have observed patterns invaded the EEG, even subjectively alert patients who lay motionless in apparent sleep, yet subjects showed a sudden shift in attention from claimed they were awake.These people seem to present reality to vaotte thoughts of the kind sleep in a higher t han normal state of physiological everyone. experiences in the midst of daily ac- and neural arousal, and it has been suggested that tivity.The Libersons have suggested thatit the fault may lie within an arousal or vigilance might be a biological necessity to I ohir the environ- system of the brain, partly located in the brain ment occasionally, entering an intermediate state stem reticu''..r format kat near f he base of the skull. between vigilance and dreaming (1,Therson and Why do these people comploin? Why do many Liberson, 1965). of them feel unrested ?Does light sleep prevent Other volunteers in the laboratory of Dr. Don- the holy from metabolizing energy in sufficient ald Goodenough have asserted they were awake quantities"?The answers to these questions ate and thinking when aroused frc.nt a dream period unknown at present, but it is reasonable to assume following a long inter%;11 of sleep. They have re- that many of these people sn (Tering imaginary portedas thoughtslong awl bizarre dream nar- insomnia are not exaggerat ing when they complain ratives, and t heir subjective confusion of sleep and of insufficient rest. waking may suggest that they sleep "lightly," for they have explained that they could control their A Neural Pacemaker dreamlike thoughts in the manner of daydreams Subjective insomnia may, in some cases, reflect and were aware of sounds in the aeon), smelt as. the subtle sleep disorder that has nothing to do with noise of an air conditiraier. insomnia. Ft rictly sneaking, lint may instead reflect Imaginary inommia is no joke to the pet son an unstable shift ing of the nightly Fl^fp pattern

3b 29 Instances of instability, a restless shifting of the Sleep Disorder ant' Mental Illness EEG phases of sleep, were noted in depressed Because sleep Disorders and mental illnesses patients who thought themselves wakeful (Diaz- almost inevitably occur in concert, sleep disorders Guerrero et al.).The possible source for this have become a cue for clinicians in discriminating apparently abT ormal cycle was recently under- between similar forms of mental illness.If typed scored by UCLA sleep studies of epileptic patients. by sleep symptoms, depressed patients, for in- A number of epileptic patients or people with stance, appear to fall into three distinct categories. intolerable motor disorders have undergone pre- Some Deople oversleep in what we have often dub- operative examination by means of electrodes bed. escapism.Others become to anxious and deeply implanted in the brain. Among them, two agitated to fall asleep at night.Still others fall patients showed a bizarre EEG during sleep. asleep easily but awaken too early in the morning. They oscillated between the lightest stages of Drugs also discriminate between types of ill- sleep, at 10-minute intervals, never showing the ness.In treating depressed patients who, by clini- brain w,,,ve patterns of deep, stage 4 sleep.Both cal classification, are anxious rather than hostile, of these patients had severe damage in the tem- certain drugs are far more effective.One kind poral lobes and showed seizures that were gener- of drug that has particularly benclitted some som- ated in the hippocampus and amygdala.This nolent and anxious patients is a chemical that in- observation is of great interest, for the amygdala terferes with a complex chemical chain that de- is known to be associated with emotion, with inte- st rot's note pineph rine in the brainthe monoamine grative processes, perhaps with short-term memory oxidase inhibitor.One such psychi-, energizer, and pituitary stress mobilization. Now there is iproniazid, has enabled several depressed patients evidence that the amygdala may regulate the pro- to function well for over a year on 3-4 hours of portions of sleep that a person spends i-' the sev- sleep, possibly by promoting more efficient brain eral EEG phases. metabolism and reducing the need forsleep Adey and his associates at the Space Biology (Bailey, et al., 1959; Kline, 1001). The differing Laboratory of UCLA have found that a chim- sleep patterns and drug responses of depressed panzee's sleep closely resembles man's.In studi:s people suggest that we have lumped several dif- of implanted chimpanzees, the investigators noted ferent ailments under a single name.Further spindling patterns from the arnygdala during study of the normal chemistry and neurophy- REM sleep, an unusual pattern that has since been siology of sleep may, indeed, help us to ascertain seen in implanted patients, but notin other the physical components of the moods and be- animals.In recent experiments with monkeys, havior of these various patients. moreover, the experimenters disconnected the Surely sleeplessnes.s, or complaints of restless amygdala and found that the animals now spent Jeep, have become warning signals for the physi- a different proportion of their sleep in the several cian.:11 any mental illnesses and sit:chic attempts EEG stages.If the arnygdala plays some role in aro hernlded by troubled sleep and a visit to the apportioning the EEG states of sleep inMll,in- doctor for sleeping pills. The connection between vestigators may be able to track a number of sleep riterl',.al illness and disorderd sleep is plain in any disorders to their neural locus.The new evidence mental institution nt night, when, despite tnnquil- suggests that while graded sleep stages in lover izers and sedatives, the hours of darkness, become animals may be govern( J in deep subcort ical re- filled with restlessness, noctutnal terror, agony of mind.It is only in recent years, the last three or gions of the brain, man and infralmman crita ales four, that sleep studies have been launched among have evolved a shift of these controls so that the the institutionalized in the hope of understanding. site of the mechanisms governing sleep have moved predicting, and controlling symptoms that are cor- into the forward regions of the brain ne.tr the related with urnisual sleep patterns. cortex.'lire amygdala, a small bulge of tissue at A survey of several hundred hospitalized psy- the front end of each temporal lobe, lit,s long been chiatric patients has indicated that about 70 per- a,:echttril --ith emotion.If this region partic- cent of them experienced sleep disturbances before ipates in the pacing of the stages of sleep, we may they were admitted for treatment.They either Login to uncover the neurop:rysologie.al lint: be- fell asleep with ditTh.ulty and a ...:.eried during t ween emotional difficulties and sleep di4orhances. Ilio night, or hart a pattern of ,,wakening ver;, 30 36 early with the feeling that they had not slept In an EEG study of 22 patients, the St. Eliza- soundly; two patterns typical of depression. beths' team has observed a great restlessness in the Many of them resorted to medical help because sleep of schizophrenics that is characterized by of their insomnia, and were administered tran- turnings and twistings of the body. Hallucinating quilizers or sedatives.Interestingly enough, there schizophrenics have also shown unusual amounts were more suicide attempts among the patients of eye-movement activity during their dream receiving sedatives or tranquilizers, than among p.,riods, and while this may have little to do with those who were given antidepressants.In addi- visual imagery, it again suggests a high state of tion, patients who said that they had been dream- excitation, poasibly within reticular activating ing less, or that they had stopped dreaming, also mechanisms.The elderly people who show signs showed a tendency to attempt suicide (Detre., et of disorientation and confusion and who cannot al., 1965). remember recent events have also been distin- At St. Elizabeths Hospital, the Federal hospital guished by different sleep patterns. Some show of about 8,000 patients in Washington, D.C., a a great deal of REM activity, but others show team of NM doctors has undertaken a long-teem abnormally little.Two volunteers, whose sleep study of the sleep of psychotics and elderly people was particularly light, awakened during dreams suffering chronic brain syndromes (Feinberg, in the laboratory, ripped the electrodes from their Koresko,Gottlieb, Wender). Here, volenteer heads and were urgent to leave the hospital for patients live for several weeks in a special ward "an appointment." These two people showed a where they adjust. to the laboratory, get acquainted great deal of eye-movement activity during REM with the st all, and are under continual observation. sleep, suggesting hyperarousal.Further studies, A very simple procedure has enabled the doctors to correlating sleep patterns, behavioral symptoms, fellow progressive sleep disturbance. and predict and responses to drugs may help to define what behavioral deterioration. A laboratory .attendant is now a rather vague designation of arousal makes a half hourly check on each patient all night, (Feinberg et .x1.,1964; Koresko et al.,1963). notingnether the person sleeps, is awake, or is in Common Disorders an indeterminate state. The resulting chart has Insomnia, restless sleep, or distortions of the produced a striking pattern. The number of awak- sleep rhythm as depicted by EEG fluctuations are enings during the night, or theamount; of undoubtedly the most common and often the most insomnia, is easy to measure and does predict de- serious complaints that come under the heading of terioration.Sleep deprivation experiments have disordered sleep. Many other sleep behaviors, demonstrated tbat lack of sleep, alone, can produce however, come to the attention of the family phy- deteriorationin behavioreven symptoms like sician. Some of these are nuisances, such as snor- those cpsychosisand that sleeplessness is ac- ing and sleeptalking. A well-known annoyance, companieci by biochemical changes in the body.It bedwetting, is relatively common among preado- is not surprising, that sleep loss, even rel atively lescent children, occurring in about 5-15 percent should exacerbate the symptoms of psychotic of them, according to one estimate.Adult enu- patients. resis is surpri ingly frequent, occurring in perhaps In schizophrenic, patients, the sleep pattern may percent of the population. The Army, an admit- enable an important diagnostic distinct ion. Some tedly selected population, has fcund bedwetting in one man in a hundred. Until recently it was patients do not stiffer sleep disorder before a generally assumed that wetting occurred during breakdown but Flee]) like. babies. This group, un- dreams, perhaps as the result of dreams, but cur- like the huger group of schizophrenics, is little rent. nightlong EEG st tidies demonstrate that this helped by I renal; zers.Possibly the symptoms is not so. suffered by these people have roots in different Drs. Chester Memo and Hoy Whitman, work- neural mechanisms.In the great majority of ing at the Cincinnati Medical Sdlool found that schiveplirenics, for whom tranqiiiiniers oiler real enuretie boys)1 5-9 and adults 17-21 generally relief from symptoms, acute episodes are usually skipped the first REM Cycles, possibly because preceded by increasing insomnia, and it has been they were unacciistomed to sleeping in the labora- postulated that these patients seller from excessive tory. Their ,cuing occurred in the deepest stage activity in the arousal system of the. brain. of sleep, st a .;e. 4.Drs. David R. Ilawkins, George 3? 31 Thrasher, and Jimmy Scott at the University of mutiny at sea, colliding with chairs and tables so North Carolina, have shown that wetting occurs violently that be wounded himself visit)l r in sleep. in several stages of sleep--generally just before a And yet, upon awokening he felt he had slept dream episode, and least frequently in REM peri- calmly.Because of its repeated association with ods, a finding confirmed by Broughton and Gas- vivid dreams in the reports follov,ing the event, taut (Gastaut and Boughton, 1964; Hawkins et somnambulism has been thought to be an enact- al., 19,f5).Children in the studies had generally ment of dreams. People reasonably expected that shown gross body movements prior to wetting, and it would occur during the REM phase of sleep when awakened reported no dreaming, although associated with vivid dreaming, a period when the apparently dreaming often followed.If many scalp EEGs bear resemblance to the waking brain sleep disturbances seem to signify arousal, enu- wave pattern, but until recently the evidence re- resis by contrast seems to occur in heavy sleepers, mained anecdotal, composed mainly uf happen- children who are often hard to awaken. Physio- stance observations or reperts to clinicians (Riser, logical resrds taken in the Cincinnati studies 1962, and many others). show that the e.nuretio child frequently has other An EEG study of somnambulism, performed disorders, some showing EEG abnormalities, some has year by a team of researchers at UCLA yielded sleepwalking, many enduring urinary complaints the startling and provocative information that such iis pressure, overly frequent need to urinate, walking did not occur in REM dream stagesbut even pain.These supposedly healthy children in the deep, slow-wave sleep of stages 3 and 4, a also had an unusually high nitrogen content in period not currently thought to be as-.;ociated with their urine (Pierce et al., 1961, 1963; Saint-Lau- intense drams. This initial study was conducted rent et al., 1963). A drug that cfre..tively lightens with 4 volunteers who had been selected from 25 sleep, imipramine, has looked promising in getting sleepwalkers, children, and adults.A special children to stop their bedwetting, but it also pro- cable permitted the subject to leave his laboratory duces an if ritated mood. bedroom, whiles wearing his garland of electrodes Teeth-grinding (bruxism) and head-banging, connected to the EEG machine, while EEGs by contrast, appear to happen mostly during were continuously recorded.Each slept in the dreaming sleep.Teeth-grinding seems to be a re- laboratory for 5 nights, and during this time the sult of normal contractions occurring in the tuns- nvcstigatONstudied 41 somnambulistic incidents. seter muscles during REM sleep but is particu- In each instance of walking or getting out of bcd, larly forceful among tense persons (Reding et the activity began in stage 3 or 4, and usually the al., 1961). subject did not remember having moved. Somnambulism As the subjects moved around, the synchronous, Sleeptalking end snoring are annoying, to others large Nvaves of stage 4 diminished in amplitude, but relatively harmless, while bruxism often causes progressing toward a lighter stage of sleep, and dental problems. One of the most eerie and fas- another interesting brain wave configuration was cinating of sleep behaviorssleepwalking is not. observed.During the actual sleepwalking, a reg- always innocuous to the performer. Somnambu- ular wave, resembling the alpha rhythm of relaxed lists have been kno).1 to perform remarkable wakefulness, entered the brain wive pattern.Al- featsto stride across narrow walls, pick their though normally the alpha rhythm vanishes when way throult furniture and negotiate around oh. r person opens his eyes, this rhytlun did not vanish stackswithoutLorin. Some, however, have when the sleepwalker opened his eyes. jumped out of windows, like the young woman, `The open eyes of the subjects lent a strange 'wooly desorihed in a newspaper report, Who was whiy to their appearance, for they walked around found in the st ;ect with broken legs. As the ex- rurniture and people as if they could scevet plait 41 to the police, the had a vivid dream of showing little sign of recognition or appearing eloping with her fiance and had merely opened indifferent.Their faces,\Vert' blank, their feet the window and Ftepped onto the ladder, which shuffling, and they did not scent to p,,rceive the unfortunately exhAefl only in her dream. Many investigators although they looked at them.One of iItc,e weird occurrences Ill ve been associated 9- veer -old boy. whoe Lenin )) a) csere brit re- Ivith traumatic incirlcnts, like the nightly straggle corded by Liolelenielry, npricent1y old ivious to !Ito of one brunch marine who rehattlad a fire and presclice of Ilsesricntisi W;11.(10101 t!ie Mold- 32 38 toring room and, 30 feet to tin end of the labo- vestigators have demonstrated, this censorship ratory, entered a kitchen, retreated and entered seems to be least strict during stage 4 sleep.If another bcirt»m, and finally returned to bed. the pathways from the sensory nerves accept stim- Ten minutes :ater, because one of his ele..,trodes ulation to a greater degree in str g3 4, one might had developed a loose connection, one of the in- wonder why the sleeping individual is not dis- vestigators awakened him in order to repair it. turbed by the pressure of bedclothes, or his breath The child remembered nothing. on the pillow, or the sounds in the room.In col- Th's study und one French study give a first loquial terms, the explanation may be that stimu- glimpse of the 5oinnambulii..f in action.His brain lation does not become sensationit is not ex- waves more ci)sely resemble those of deep sleep perienceduntil it has been processed and inte- than those of ,he waking state.However, they grated by the brain.Studies of evoked potentials are different.This may point to another state strongly suggest that these integrative functions of vigilance apart from waking or sleep, a state aro not operating in their usual way during stage in which there is usually reduced awareness of the 4 sleep.This evidence has been seen in several environment, but in which comp'ex and even vio- specks of animals and in humans in studies con- lent acts requiring interaction with the environ- ducted by a number of scientists (Burton S. Ros- ment may be performed (Jacobson et al., 13G5). ner, Jose Segundo, Raul Hernandez-Peon, and Evoked Potentials others). How could a person see--take in visual and In attempting to offer an anatomical hypothesis other sensory informationat a. lowered level of to explain the EEG responses, two investigators vigilance and without remembering? Why dur- have phrased it differently.Dr. Hernandez-Peon ing stage 4 sleep?Quite a number of neuro- of Mexico City postulates the existence of neurons, physiological studies have offered data that may within or near the arousal system, that are essential explain this apparent. paradox.One method of to conscious experience.If these. brain cells are determining how the brain responds to a signal in act ive when the arousal system beconua inhibited during each of the stages of sleep is to sound a during sleep, the brain might receive sensory sig- click in the ear of the sleeping animal or person, nals yet never generate awareness.Dr. Burton flash a light, or deliver a very gentle electric shock S. Rosner, at the University of Pennsylvania, does throughout sleep.By performing the stimulation not explicitly post nate "conscious experience neu- repeatedly, and by superimposing the subsequent rons."However, he feels that the diminished brain wave records using an averaging technique, amplitude of the later portions of the EEG re- it is possible to gain a clear picture of the charac- sponse may mean that there is a functional change teristic brill) wave pattern that follows.This in the brain regions believed critical for conscious- evoked potential can tell something about what. ness--the association area and diffuse projection parts of the brain are responding., how rapidly s: stein of fibers from the core of the brain that they respond, how sizable the response is, and how finally transmit sensory information to the cortex. responses to any particular stimulus compare in the sleepwalker may indeed receive a bom- wrking and the stages of sleep.Brain wave re bardment of sensory information, yet not "experi- sponse, to stimulation, obtained from animals ar.d ence" anything.Although any speculation on the from normal people in waking and sleep, have neural organization underlying this strange phe- shown that the heaviest censoring, of seisciry stim- nomenon is (mite tentative, it does SUM that stage ulation must occur during waking and REM sleep. 4 sleep may permit automatic. yet complex- behav- In other words, the signals coining from specific iorinvolving certain receptor and effector sys- sensory channels produce less of a response in the tem:- -withoutthevisualin volvimeotof that EEG in ivaking and during dreaming, than in deep fflYsferiolls makestt resPnnsive sleep. lira; a also conscions. There are indeed many differences ton ramified reseandi tools and a variety of re- for smilinal.y here.However, it \void] seem that searches should help Hs to further penetratehe theakin!! and llEM dreamily, brain maintain perplexing plieromenti of sonnialoimli,i» mid to afo,is of attention by ino-t of the lincicr.trind %illyit14 FO oftn itii chins OfL,ii-oty signal.;fl,,m entf1;11!!5.jIlifi- vivid itromijilo,;11111011;41111Illit'Fz -,1 far Live indi- Cnlly into theAin.Oddly enough, as ntany in- cated that inter-e ill ea ming doe.;noI. ardly oeeur, 39 33 or is not recalled from stage 4 sleep.The fact dolly bega:a sleeping by day and remaining awake that sleepwalking is frequently observed among throughout the night. This sudden shift of sleep entireties, in whom urinary problems are commas, and wakefulness in the track of a brain-ch.maging and who show unusual urine nitrogen content, and fever emphatically suggested that there a as more sometimes slight EEG abnormalities, may suggest than convenient habit to the sleep eyele of man. a biochemical factor. Surely the cycle, however it was developed by We are just on the threshold of understanding whatever training, had some residence in brain the metabolism and the neurophysiology of sleep. mechanisms, perhaps, a brain clock that would Indeed, we still know little about, three very con- turn sleep on and off, so to speak. With his ob- spicuous diseases associated with sleep--enceph- servations of hypothalamic lesions, Von Economo, alitis, narcolepsy, and epilepsy. during World War I, postulated that the brain must contain a sleep regulating center, and that Encephalitis the hypothalamus contained one area that induced In parts of the world where sleeping sickness is wakefulness, while another produced sleep.Thus common, a resistless drowsiness is a frightening the epidemic of encephalitis, with all its frightful omen.Attncks of somnolence, lasting days or even abnormalities, inspired theories about the region weeks, may come from many causes, among them of the brain stem or brain that must participate in brain tumors, lesions, damages from malaria, the normal regulation of sleep.It was a striking chicken pox, German measles, syphilis, and other example of the way in which ;abnormality of be- highfever diseases.The most dreaded sleeping havior may help the scientist to uncover the normal sickness of them all, howeN er, is encephalitis, which process of behavior.Although the early theories is mused by a virus.Although it appears in many were inadequate, they generated what is now inten- forms, it generally begins with fever, delirium, sive neurophysiological study of sleep regulation sometimes to be followed by periods of agitation in the brain (Kleitman, 1963). and insomnia, then stupor and coma. The virus raged through Europe during World War 7, f re- Narcolepsy gently taking its grip after a weakening siege. of Encephalitis is well known by name at least influenza.It inspired considerable medical re- to the public, for it is a fairly common disease search. and Von Economo and others sought in in many parts of Asia, and outbreaks in Europe autopsies the site of the damage vithin the brain. and the United States have generated a sizable As the data accumulated from uglily analyses of legend and literature..Most people, on the other brain tissue, it became clear that the ravages of the hand, have never heard of narcolepsy. Although virus were not restricted to a particular small spot . this curious ailment had the status of an extremely in tha brain.Lesions, or what might be called rare illness until recently, it may not be rare at neural scar tissue from the death of brain cells, all, for many people endure i's symptonis with- were found in the hypothalamus, that portion of out having a name to call them.Narcolepsy is brain just above the palate in man, which governs, mainly characterized by a tendem.'y to fall asleep appetite, body temperature, heart rate, and emo- easily and at inappropriate moments.Before tion.Depending upon the location in the hypo- their problem,: were diagnosed, a number of nar- thalamus of brain cell damage, there could he coleptics have fallen asleep at the wheel of a car many different of and lesions were also found and crashed into a building or tree..1 more in many , r10111011Sof Ih^ brain,Thus, suh- frightening symptom of many narcoleptis: is an sequent s ins began to explain the array of overwhelming, swoonlike reaction to intense emo- prepostei effects that. encephalitis had vreaked tion.Violent auger or laughter literally makes. upon its v, tints.In some instances the victims them ,veak vith emotion, and they may lose. nil of the disease were known to sleep as long as 5 muscle tension, falling to the floor and sometimes years.Thus encephalitis, especially in an epi- into a brief sleep that resembles a blackout. This demic, called attention to the role of the brain in cataplexy afflicts nhout GO percent of the nar- causing sleep or wakefulness. coleptics.Sleep paralysis isiiicither One symptom was part kill rly revealing.In symptom: narcoleptic:, have 1.,,porte,1 ;1,k-nliening the afterin,,th of fever, especially317101,e1111111T1), but being unable lo move forF(11110 1011111R.z. then? was often a shifting er even a ill al inversion People with these seemingly FiniAcr symptoms of the diurnal sleep cycle, so that the patient slid- have gone to doctors, claiming they were epileptic, 34 40 or eve-t insane.Others, prone to napping, have remain unconsciousinrrude into waking life. deprecated themselves for laziness. A great num- Waking hallucinat ions, cataplex3-, and £ Jeep paral- ber of narcoleptics have sought help from optom- ysis are exaggerations of the events time normally etrists, ophthalmologists!, and oculists, believing occur in the REM stage t f sleep.Cataplexy, for they needed glasses because they sufTereci from an instance, is not a blackout.. However, if the normal inability to focus their eyes (Keefe et al., 1060). person, standing on the street corner, were sud- Actually this double vision stemmed from narco- denly to lose muscle tone as he does in REM sleep, leptic drowsiness.There is no way of knowing he would fall limply to the sidewalk. If he were how many Americans suffer from narcolepsy, -nor to fall asleep at the same I ime, with such swiftness, how many industrial or auto accidents are caused he might think he had fainted. by sleep attacks.The ailment may, indeed, occur Recent studies of narcoleptic sleep attacks were in very mild form so that some people would bo performed on Volunteers at Stanford University. relatively untouched by its symptoms.Drs. D. One indication that the ailment is not so rare as Daly and R. E. Voss of the Mayo Clinic have once assumed was the response of narcoleptics to studied narcoleptics of every degree of symptom an athertisement in a San Francisco paper. A and feel that narcolepsy occurs ir, many degrees call for volunteers drew a large number of replies. of severity (Daly and Yoss; Yoss and Daly; Screening the volunteers was simple.Could the Ganada; Gastaut and Roth). person fell a funny joke or spank his children with- A totally new understanding of narcolepsy has out suffering a cataplectic fit ?Did he suffer from been generated by the collaborative studies of Drs. sleepiness?Because laughter or anger seems to Allan Rechtschaffen, William C. Dement, and trigger cataplexy, most narcoleptics learn to avoid George Gulevich, one which should erase the me- these emotional situations and divert their atten- dieval aura of fear about the syndrome.Follow- tion from the events that might endanger them. ing a hunch that the symptoms were related to the Although the symptoms are outstanding, five of REM stage of sleep, the dream period, a series of the cataplectic volunteers in the Palo Alto studies EEG studies were undertaken. One early study had never had medical attmt ion.At present it showed that a narcoleptic can hold a conversation, appears that two-thirds of the narcoleptics sutrer discriminate between sounds, show other signs of eataplexy, but that about one-third do not. being wide awake, and yet have the brain wave The fact that there are many cataplectic people pat terns of someone deeply ,tsleep. A narcoleptic, walking around without medical help is astonish- wide awake, has skin conductance like that of the ing in itself, but it is even more astonishing in the normal person asleep. An EEG survey of nine light of the new EEG and physiological data. The narcoleptics and nine normal controls quickly attack can occur like lightning.One volunteer, showed one difference in the sleeping patterns. A a woman, had been outfitted in scalp and other normal adult, according to hundreds of EEO elect rudest prior to EEG, eye movement, heart, and studies, will sleep for about 00 minutes before en- respiration measurements. She sa:, in a chair in tering a REM period.The narcoleptic will, on the recording room and was instructed not to fall the other hand, begin a RE\f dream immediately asleep until the investigator had gone into the after he falls asleep. adjacent control room. Iroweer, as he closed tl,e Nobody knows how narcolepsy is caused, al- door a second later, she was asleep.Ire awakened though statistics about the syndrome in family her and dashed to the elmtreencephalograph ma- groups suggests a genetic propensity. Some doc- chine in the next room. By that time she was al- tors have supposed that a brain disvise is the ori- ready dreaming, showing the familiar brain ,wave gin, and that this disease causes an adult to regress and eyemoventent patterns of REM sleep.The to the potyphasic sleep pattern of the infant, in instantaneous fall from wakefulness into REM which sleep occurs in 50-minute cycles. The cur- slem is a rare occurrence. It can happen after pro- rent studies of Dement. and RechtschatTen have, longed dream deprivation, or withdrawal from in any event, demonstrated that the narcoleptic's amphetamine drugs, but the normal iserson does bizarre symptoms are merely the symptoms of nor- not experience sleep in Ns way 0MA:sell:igen mal sleep, but very ill-timed.It is not that narco- et al., I063; Denvult et al., 1061). leptics need more sleep than normal people, but In studies of na sso?s-,s- .at Stant( rd University the, pha nomena of sleds -of which most of us and the University of Chicago, narcoleptics %vete

i41 35 observed plunging instantaneously into dreams. and brain regions that participate in sleep suggest Normal volonteers took about 50 minutes of sleep two areas Iliet may be affected. Extensis a work by before they showed signs of REM sleep, if they did M. Bouvet and others at Lyon has shown that the at all, during daytime naps.It is not surprising pans, a region of the brain stem that is phyloger2t- that tho narcoleptic has a vet), di fferen t subjective ically archaic, plays a large role in generating experience of sleep. The normal adult slowly re- the characteristic HEM sleep that is fonnd in laxes, going through a long transition before he animals and man.This might be one locus of loses muscle ti)I1D in his face int d reek as the RENE narcoleptic, seizure-.Other possible loci may lie period begins. The narcoleptic, on the other hand, in the temporal lobes, in the hippocampus and fods weak when he is sleepy, and many report amygdala,fo ..forwardinthebrain.These strange sensations in the muscles.The sleep frontal areas may act as a clearinghouse for paralysis they may experience probably involves memory and emotional information, and there has the lack of muscle tone accompanying REM been some recent evidence that the amygdala may sleepbut in the awakening narcoleptic remaining help to regulate the EEG phases of sleep. A muscle tension may be. delayed by quite a few sec- wealth of data linking emotion and sleep has sug- onds (Dement et al., 1961; Rechtschaffen et al., gested to R. 1fernandez-Peon that narcolei tic par- 1963). oxysms may originate in the amygdala--an hy- One peculiar aspect of narcolespy is its periodic- pothesis soon to be tested. ity.Frequently the narcoleptic will suffer attacks Although we may not know the exact chain of at intervals of 4 to 6 hours.This suggests an es biochemical events, and while, we. cannot yet pin- yet unknown metabolic cycle.Possibly the body point the brain cells that e tivate narcoleptic at- generates a chemical during wakefulness that is taLks, it is obvious that the sleep research of the used. up during REM sleep, and the narcoleptic last. 5 years has been applied in an unprecedented either overproduces this metabolite, or does not use wayto the benefit of evely person who suffers it up in nightly sleep. A series of animal experi- this malady.Findings front the many studies- - ments at. Stanford University Medical School may which are the content of this reporthave been reveal whether the REM state is triggered by a focused upon this strange syndrome in order to neurochenaical that is consumed during dreaming illuminate its nature.It must come as a relief to (Henry et al., 1965). physicians and patients alike to realize that the The psychological quirks and neuroses of narco- symptoms are those of sleep a id dreaming.Ele- leptics are difficult to assess. Surely the symptoms ments of the familiar always help to remove the place an incredible strain upon a person's life and dread of a bizarre mystery, removing some of self-control. A person who is overcome by a resist- the psychological burden.Moreover, there are less slog) attack in the midst of making love, or now some guidelines for a regime of medication to who drops to the street if he listens to a funny joke minimize the symptoms. and laughs, might be expected to develop some Sleep loss appears to enhance narcoleptic at- unusual behavior in reaction.?Iowever, the frct tacks, and, indeed, narcoleptics appear to be rest- that emotion can trigger the sleep attack has in- less sleepers.However, most of them take dexe- trigued people who have tried to understand its eti- drine in order to stay awake, and this alone ology. A survey of the literature indicates that may change their sleep pattern. Among other many narcoleptics suffered their first attack after effect s, dexc iLrine reduces the amount of HEM sleep a trauma that occurred in early adolescence. Many (Rcchtschaffen and Moron, 11161).Pierce and of these were children of about 13 to wl.om a death his associates Miss Olivia Nixon, Drs..1. L. Mathis, in the family caused sudden and int Nrta emotional and 13. K. Lester have observed that several narco- upset. This may be precisely the kind of emot ional leptics had less than the normal amount of REM jolt that Richter postulated when he predicted that sleep.Itis interesting that a couple of them trauma might cause the normally out -of-phase brought tugs of sandwiches to the laboratory to metabolic cycles to come into )baseproducing eat late at night. A tendency to overeat has been st range symptoms in a peri(xlic not iced in voluincers who deliberately underwent .11tho111 we arc still a long way front being able ! con,let,' lrc, for several night:, and to trace the concatenation of metabolic events- that sugge,t; illtcra of appetite meellani:ro.; may be involved, studies of the Train inechaniFins in the brain with sleep.Unfo, tunately, because

36 41) dexedrine has a hangover effect, many narcoleptics clothing. Epileptic seizures are often mild enough are continually raising their dose. The result may to escape medical notice, sometimes passing as be that they are further depriving themselves of lapses in attention or daydreaming. REM sleep at night and compensating with REA The link between epilepsy and sleep is just begin- attacks during the day. Clearly, in the treatment ning to be explored.Each form of epilepsy of this syndrome, the patient needs a drug to keep appears to induce seizures that cluster at a partic- him awake by day, but he needs a sedative at night ular time in the individual's diurnal cycle.In- that does not reduce REM sleep. A combination deed, the time of seizures may prove to be a (le- of the tranquilizer, Thorazine, and dexedrine has aning characteristic of the particular kind of been tried with good results.If, instead of taking epilepsy.Most common are seizures during sleep, dexedrine by day, the patient could take a drug and waking attacks are often followed by sleep. at night to enhance his REM sleep, his daytime Like the narcoleptic, the epileptic is vulnerable to attacks might be decreased or even erT.dicated. So sleep loss and is warned to avoid exhaustion. Some Drs. Dement, Gulevich, and Rechtschaffen have epileptics are triggered by emotion, and, like the hypothesized. During the past several years, for eataplectic patient, will be catapulted into a seizure many reasons, there has been a search for dream- by aheartylaugh.Psychomotorepileptics, enhancing drugs, but this research is just begin- whose seizures emanate from the temporal lobes, ning and no such drug is yet available. do not go into moments of unconsciousness, but The data from sleep research, enabling the recent live through episodes that resemble waking dreams studies of narcolepsy, have already providad the which they do not remember.Because certain physician with invaluable tools.For diagnosis, seizures occur only during sleep or drowsiness, a simple battery of testsincludirg EEGs of EEGs have been used in diagnosis for about 25 sleep onsetwill indicate narcolepsy and distin- years.Until 1058, however, patients never slept guish bet ween the eatapiectic and noncataplectic more than an hour or two in the laboratory, and person.One of the revealing tests is absurdly moreover, the electroencephalographers usually simple: can the patient tell a funu3 joke, or open- interpreted the REM stage as a period of wake- ly enjoy a joke related by the doctor ? A regimen fulness c n those few occasions when they sa 4V one. to prevent sleep loss and further loss of REM Today, when sleep study is warranted, nightlong sleep can be prescribed, and the doctor can re- EEG records are taken and interpreted according assure his patient that the untoward "spells" are, to recent findings on the normal patterns of nightly indeed, just misplaced sleep.Perhaps publicity sleep. will help to take some of the psychological onus One of the first indications that sleep might be from narcolepsy and enable people with symp- a state of high brain activity, signs that the brain toms, however mild, to seek relief. did not "go to sleep," came front epileptic seizures Epilepsy during sleep.Many decades ago, Dr. J. Hugh- widespread publicity campaign has been hogs Jackson, the great 10th century neurologist, undertaken to remove the onus from another dis- suggested that sleep must be an active brain slate, ease associated with sleep rnechanismsepilepsy. after noticing that seizures often occurred as a In the popular conception this ailment has been person was falling asleep.Anybody who pays imbued with mysterious, visionary overtones, and seine attention as he drifts off to sleep will notice the epileptic fit, is perceived in Dostoevkian force occasional muscle twitches, sometimes startling as a grand mal seizure, beginning with an aura, laxly jerksThey are very minor convulsions, and ending in violent convulsions, with the person generally called myoelonus.They are brought foaming at the month and finally entering coma. about by a hyperactive state that impels certain Actually, like narcolepsy, epilepsy is a syndrome nmseles to coot rust.Myoclon;.2 :yams are hardly of many forms and degrees, moderately rare in the same as serious convulsions, but they are grand mal proportions, although not uncommon hated. A study of the behavior of single bra 'n cells, in less severe manifestations.In1.1)i Angeles especially in regions that transmit impulses to the County alone, 0,600 to So.000 people suffer one muscle system, has begun to explain how these and or another of its symptoms Cenerall..., these are other seizures may be generated in the brain. not "lits," but brief epicales of blankness auln- Although this e.orki=far 'moved from the mat ie behavior--snwking of lips or fumbling with clinic and the epileptic himself, a brief description 43 37 may suggest what the nature of a seizure might be nature of the inhibiting mechanism that prevents in its most atomic formthe discharge pattern of great bursts of cell firing now continues at several nerve cells within the brain. levels.Although the single brain cell is the atom Single Brain Cell Studies of consciousness, many clues into the nature of Using cats and monkeys as experimental sub- epilepsy must come from molar studies of patients (Evarts,1963,1964). jecti;, Dr. Edward Evarts and colleagues at NM hays placed miLroelectrodes into various brain When dilantin and other drugs fail to :.oppress cells in different regions of the brain, taking EEG intolerable seizures, a person with really severe recordings from each cell individually. t is epilepsy will consider neurosurgery, during which the difference between the cell's activity in sleep the source of the seizure is rendered inactive by and in alertness?Until recently people guessed lesion.In many instances the locus is deep and that cells were simply more sluggish, that they can be found only by placing electrodes within the fired less often during sleepbut this is not the brain and then studying the person's brain wave picture offered by the cells.Some cells,for patterns as lie sleeps, as he reacts to stress, mat-es example, located in the visual cortex, would fire a decision, moves, or perceivesclicks,lights, more often and respond more rapidly to flashes of touches.At the Nettropsychiatric Institute of light in the animal's eyes if he were asleep in the UCLA, where over a dozen such patients have REM state, than if lie were awake. On the other been studied, it has become apparent that night- hand, there were certain cells that became more ac- time seizures rarely occur during the REM dream tive when the animal awakened. A sampling of phase. Indeed, they occur especially often during many diverse cells showed what might be called a stage 2, a period in which the brain waves show a division of labor, some firing more continuously wave form that looks like a wire spindle. The and rapidly in waking, others firing more often REM state resembles wakefulness in many ways, and rapidly in sleep.But the pattern was not so perhaps imposing the same inhibition upon unruly simple. cells, whose activity erupts in the other stages of Evarts and his associates turned to the study of sleepan hypothesis suggested by both the animal monkeys. They implanted their virtuallyin- study of single cells and the human patient.Un- visible microcleet rode tips into neurons of the py- til recently, our picture of brain ware patterns ramidal system.The pyramidal tract. descends to from deep sites during specific sleep stages had the spinal cord at the base of the brain stem, and entirely depemied upon implanted animals, We this system relays outgoing messages from the have had no way of knowing .whether the hippo- cortex to the motor systemtranslating the desire campal patterns of cats in REM sleep re=cmbled to move a foot into the command that moves a foot. those of dreaming man.Conversiy, we did not I 'ere, in the many studies of their survey, they saw know how to interpret unusual brain waves coining that cells followed different patterns of firing from the amygdala of a sleeping epileptic. Were during the different EEG stages of sleep and wak- these signs of abnormality or were they also seen ing.One cell might fire in a regular, continuous in :nil neds dur lig that stage of sleep? pattern (luring waking, but fluctuate wildly luring A happy collaboration between the neuropsy- REM sleep. Many cells elsewhere in the brain cliiatric hosph al and the Space Biology Labora- have shown a random discharge pattern during tory of W. Ross Ad,/ has permitted some rapid waking, but have tired in el isters or bursts during and comparisons of humans and pri sleep, interspersed with it vials of silence.In- mates.One extremely important discovery has deed, on closer scrutiny, it clued clear that the centered around activity in the amygdala in man waking rhythm of certain N amide] cells was not. and chimpanzee. A diseased nmygdala is often random.Rather,it appeared that\vitenthe d,soeiated with psychomotor epilepsy and is there- anim.,1 was awak,, these cells we :e inhibited to fore one of the regions that has bee,' probed with some extent, but win n the nnini al slept this pre- electrode, in c, rain cases. As meent studies have ys ling dainrer seemed to he removed.Now, un- indicated, the sleep (tl,e chimpamee closely controlled. the cells 'night discharge large senildes that of -nun, but so de patterns found ii This k the kind of (li,clinyv.0 that cmses the chimp awl inhave not Is-et) seen in other s iZU Is and sle,.NS up on the scalp FEG as a great even 'thus awe must 110 cau- spikefol matinn.Further explorationof the tious about gererali/ing ,nom lower animals to 38 44 man. One particular observation in the chimpan- possible to dispel tho fearsome mystery of narco- zee laboratory, however, has clarified a potentially lepsy and outline more sensible procedures for disturbing brain wave pattern seen in epileptic diagnosis and treatmmt.

patents.This was a discovery of spindling pat- Because sleep loss ,-' ems to be so generally de- terns in the amygdala of a sleeping chimp. When structive to the mentally or phy. ically ill, and similtr bursts emanated from the amygdala of a because of the evidence about the impact of sleep patient, they might have been mistaken for abnor- starvation in normabpeople, it might Si can reason- mal signs had the neurosurgeons not known that able to prescribe sle. ) therapy for many disturb- the same spindling was found in normal chimpan- ances. Sleep then )y has indeed been used in zees. The recent finding, in Dr. Adey's laboratory, Europe, Russia, and South America for people that the a myplala may partied) te in the periodic suffering psychological disturbances, the long 1;e- cycles that form our nightly sleep, points to this riodsof sleepinducedusually by sedation frontal region of the brain as a point of particular ( \ ndre,ev, 1960). interest in future studies of sleep, elucidating the More recently, some investigators have talked mechanisms and the sources of many abnormali- of using electrical stimulation instead of sedatives. tiesepilepsy and narcolepsy among them (Adey Sleep has been induced in animals by direct stimu- et al., 1963). lation of certain brain regions, but the evidence Summary from human studies, using surface contacts, Ins Sleep disorders and disorders occurring within been inconclusive. There has been some confusion sleep have provided spore for the scientific hunter, about electroileep, or electronarcosis, and elec- suggesting where. to look for the normal mecha- t roanest hesia. nisms of sleep, and how they night work.Most The Russians, using a device similar to an elec- diAttilicd sleep has had its counterpart in a dis- tromiesthesin Ili:whine Ion,: et iiployed in European rupt ion of to behavior, but only in die last animal laboratories, have been credited with pro- few years have we begun to look at the particular ducing a sleep with such restful qualities that 2 symptoms of troubled sleep for help in diagnosing hours, would suffice for 8 hours of sleep.Widely disturbed behavior and for guidelines in our thera- mentioned as a substitute for nightly sleep, the peutic techniques. Insomnia, the most widespread "Elekt roson" or similar device:, were tried by a complaint, is a good example. The difference be- few American s,-ientPs. heportable device tween people who cannot fall asleep, andpeople generates low-frequency pulses. throng'. -lec roles who cannot remain asleep may prove to stem from on the eye.: ;111(1 oecipi!I region of the scalp, pur- two separate neurophysiulogical defcctssuggest- portedly to create rhythmic stimulation of the ing that the sedatives used for one insomnia may cove cel IS in the l'Ortlral corn . 1:afoi ornately, inalTropriate for the other. teniandez-Pcon this:situation does not inevitably prod m c sleep, and sugge-,ts that emotionally triggered insomnia a,n1 although the specifications of the device say that inability to fall asleep may spring from an exces- it is intended for inducing sleep electrl. ally, E01110 sive activity within a brain area producing arousal. people in contact with the Russian investigators 1 he inability to sleep through flu. night, on the feel that Flee)) is a misnomer, and that the device other hand, may coma from an insufficient clienneal was never intended to induce natural sleep.It is supply within a sleep engendering system in the widely used throughout Russia in hundreds of brain, making it incapable of holding dominance clinics and "sleep stations,'' for treating headaches, over arousal.Imaginary insomnia, at least inso- insomnia, certain forums of schizophrenia, epilepsy, far as our slim evidence now tells may a. fled stomach ulcers. and neurotic symptoms following an unusually light sleep or even unusual periodic- head injuries As a device for "resting the central ity among the. EEG stages of sleep.Wlion we nervous system," in people with mental illness or have learned more about the chemical and licural psychosomatic disorders, the Russians evidently nicelianimis of normal slab we will be in a Liter find this an efficient and successful met he I.Fit_ pHtion to treat the many psychological aberrl- fot tunately, taking literally the ,, 01.{1":-11'1,.. :IS I ions that a,comp In) these disorder:. for sh p dis- used in the literature describing the EIckt roson, we order does not o...air in iolation f rem the (4 have ,,.omamt rated our attention ni ..,1 the fact 11,a1 life.liven 174/1:!1()(13.1'.S =early and rc. ently ti^- when tinned ()tit the :linitiht,ion L u1 not IF:11111.1. quired knowledge of sh.ep pat fe, IF,it has been left ihe person in natural sleep. Dr. Sigmund For. ' YJ 39 ster, at New York Downstate Medical Center, describe how we alter the natural pattern vith var- found that only half of his subjects fell asleep ious drugs, changing the brain's activity during after electrical stimulation, but patients with mus- the several sleep stages and thus, perhaps, affect- cular disorders experienced relief from symp- ing many body functions including metabolism. toms.So few systematic studies have been con- Sleep no longer looks like a unitary process, and ducted in this fruitful and interesting area that sleep disorders appear to arise from many dif- it has been hard to assess the results.Dr. James ferent sourcesinvolving the behavior, training, A. Lewis at Brooks Air Force Base, San Antonio, environment of a person, his body chemistry, and Tex., has reviewed much of the electrosleep liter activity at various sites within the brain.Sleep ture, but this sole review is as yet unpublished. therapy in the future will undoubtedly be tailored Electrosleep, as judged by EEGs is not the to the specific disorder as we discover more about same as natural sleep, nor, in a more subtle sense, the little-known chemistry of sleep and the way in is the prolonged state that is entered under heavy which body chemicals exert their influence on the sedation.Recent sleep researches have begun to brain.

40 Mandragoras ... the ?aot seems to be a maker of love medicines. There is of it one sort that is foemall, which is black ... But of ye male, and white, which some have called Norio?, ye leaves are greater ... sweet smelling with a certain strongness which Gi80 ye shepherds eating are in a manner made asleep ... And some do wilt the roots in wine to thirds and straining it set it up. Using a Cyathus of it for such as cannot sleep, or are grievously pained ... Celsus

Mandragoras ...This is of a strong Narcotic Quality,and is mentioned in some ancient Writers as convenient to be given before an Amputation, to deaden the Sense of Pain by stupifying the Patient: but modern Practice owns it not for al.y such use.It is . eckoncd cooling in external Applications. John Quincy, 1745

Chapter V. The Chemistry of Steep Whatever elixirof mortaljuices helpsto ral origins, and each demands drugs with particu- prompt a wholesome nightly sleep, it must have lar properties.The brief description of some been inadequate in 1064, for difficulty in sleeping Major sleep disorders in a preceding section may was a boon to the American drug companies. Ac- indicate the -variety of different things that can go cording to an estimate from one company, private wrong, each hinting at a specific therapy. consumers spent about $80 million on sedatives, In our present and rapidly growing picture of and this figure included only major prescription sleep events, it looks though some people, nar- sedatives, not over-the-counter drugs, or the siza- coleptics among them, would be benefited by drugs ble purchases of hospitals. that increase a particular phase of sleet - --the REM In answer to the public clamor for aid in illness, period of dreaming.Enuretics and somnambu- in transitory or prolonged insomnia, the prescrip- lists appear to need very different phrrmaceutical tion market ofered a sophisticated array by any help, perhaps lightening sleep.Others, among past standards. Not so long ago the family physi- them certain depressives and epileptics, may re- cian might have prescribed chloral hydrate or "a quire chemicals that help to stabilize their sleep good stiff drink" in most instances. Today seda- phases.Schizophrenic patients may need drugs tion is no so simple (Lester, 1060). The doctor that enhance REM sleep before the omens of might distinguish between the insomniac who acute episodes. wakens periodically and the person who cannot These are, of course, only guesses at the moment, sleep out the night.One case might warrant a omitting large and unexplored factors from or- drug that induces rapid sleep onset, and the other gans such as the liver, glandular systems produc- a drug that tends to maintain sleep. ing hormones, the role of learned behaviors, and Still, the refinement suggested by our present. physiological response to the environment. They nrr.)- of drugs does not belie the fact that we con- may, however, illustrate the new approach rapidly tinue to remedy sleep disorders in a relatively entering the treatment of disorders which have, primitive fashion, and that even what we call in- as one noticeable component, symptems in sleep. somnia has many roots, whether it be a transient As we begin to face in greater detail the task emotional upset, a facet of depression, of old age, of countelg nature's mischiefs, there are three or the prelude to acute schizophrenic breakdown. lines of current resear-h that offer a heartening Primarily, these have different metabolic and nem prospect.Although this is a crude designation, 4 1 41 they might be considered together as investiga- ing of these reports?Some recent studies are tions of the biochemistry of sleep.Using chem- beginning to point to differences between barbi- ical stimulation directly on the brain to elicit sleep turates and tranquilizers. and wakefulness, some investigators are attempt- A series of behavioral studies by Drs. Conan ing to decipher the chemical codes involved in Kornetsky, A. Mirsky, and their associates at Bos- neural activity and determine their anatomical ton University Medical School have been devel- sites.Others have begun to detect chemicals oped in the hope of determining what regions of generated within the body or the brain that influ- the brain may be affected by psychoactive drugs. ence sleep and allied behaviors; the detection of They began by seeking tests that discriminate be- these chemicals oilers some hope that we will learn tween drugs that depress attention and those that to synthesize and use them.Finally, in studies depress intellectual or cortical activity.Experi- that have an immediate and practical outcome, mentation and long use suggested that a segment some researchers are ferreting out the specific ac- of an early IQ test (the Digit Symbol Substitu- tion of the chai`ns we commonly use, and indeed tion Test) was a good measure of intellectual func- the effects of diet. The promises and pitfalls of a tioning, and it was short and easy to administer. good deal of this recent work hale been reviewed On the test, the subject, is given a code by which by Arnold Mandell, with reference to the REM he matches symbols with numbers on a grid. state of sleep (Mande11,1965). While sew-itive to intellectual performance, this Little enough is known about soma of our most test would not catch lapses of attention. By con- common sedatives.I lowever, impact on behavior trast, the Continuous Performance Test asks the has been one very useful gauge by which we can subject to give unremitting attention to a stream distinguish between drugs. During recent years, of signals, aim to respond to certain ones.Here, both sedatives and tranquilizers have been given the omissions of brain-damaged people, or the to patients to help them sleep.At the level of sleep- starved, or those taking attention - depressing anecdotal observation, there seems to be quite a drug,s were detected. By using these two tests it difference in result.Some clinicians have com- was possible to divide psychoactive drugs into mented that many patients who come to the clinic those that affect attention and those that affect asking for sleeping pills, in retrospect seemed to cortical activity (Minsky and Kornetsky, 1961). be suffering from the symptoms of incipient men- Two drugsone a tranquilizer (chlorproma- talillness.Given barbiturates for sleep, some zine) and the other a barbiturate (secobarbital) may become depressed and even suicidal (Detre seem very similar on the surface, for both produce ct calm and drowsiness and may leave a slight hang- There seems to be little evidence on this point over. Compared by these two tests, however, they at the moment, althou:*h a very large number of are opposites. The tranquilizer reduces attention Americans take their lives each year by swallow- without damaging, intellectual function: the bar ing an overdose of sedatives, some of them inad- biturate, on the other hand, leaves attention un- vertently, it is said, while acting in a sedated con- diminished but reduces intellectual performance. fusion.There are over 20,000 suicides a year in This suggests that. while both drugs may induce the Uhited States. A mat y-faceted study of sui- sleep, they may act upon different parts of the cide under the direction of Dr. Edwin S. Shneid- brain and perhaps different chemical brain sys- man at the Suicide. Prevention Center in Los An- tems.This laboratory is developing apparatus geles has already suggested that disturbed sleep that will make it possible to give these two tests may be .3ne of the. patterns preceding a suicide to animals. Once there are parallel tests for drug attempt, although any influence of specific hyp- responses in animals and humans we may be able notic drugs has not yet been revealed. to test drugs on animals and predict more accu- Drugs srs- commonly given to institutionali7.ed rately how they will affect 'lye! Ie. schizoph7enir lint lents to help them sleep.Ironi- The I .'cont work at Bo: mt University may sug- cally, some of the barbiturates that indime sleep gest one tvm-on why schiYophrcnie patients have in the pvient are not th?t;tpentie and actually benefitted from Imnquili, more than sedatives. appear to mike him worse.Such has been the Chlorpromazine gis -II to a normal person will de- observation of as NIII team at St. Elizabeths press attention so that he makes many cull, s on iu Washington, D.C. What is the mean- the attention test, as if lie had here deprived of

42 4 8 sleep. The schizophrenic on the same dose, shows nights without drugs (Rechtsehaffen and Maron, no loss of attention in comparison with his un- 1964).It was as if they had developed a "need" drugged performance. Perhaps his problem is one for REM sleep and this REM hunger, so to :peak, of too much neural alertness. may help to explain the psychoses of habitual alco- Chlorpromazine helps a schizophrenic patent holics, barbiturate addicts and dexedrine takers. sleep without intensifying his psychosis. A num- Temporary psychoses are not uncommon after ber of investigators ha-e anticipated that there taking these drugs and sometimes the individual would be a visible difference in the EEG sleep pat- may be suffering the effects of all three by the terns produced by tranquilizers and sedatives time he conies to a clinic or mental institution. (Freeman et al., 1065).In one study of hallu- Dexedrine is currently used for appetite control cinating schizophrenics, a St. Elizabeths' team in daily doses, and the attempt to lose weight in saw that both drugs diminished the amount of this Way can be the start of a vicious circle. While REM time in the sleep of psychotic patients but depressing appetite, amphetamines also enhance that the barbiturate, phenobarbital, significantly vakefulness.The weight foal' may, therefore, reduced the amount of eye-movements that oc- begin taking barbiturates at night in order to curred in the REM stage.Moreover, when the sleep.13ut some sedatives leave a hangover of tranquilizer was discontinued, the patient seemed sluggishness in the morning and therefore the per- to compensate by increasing REM time, but no son may increase his dose of dexed rine, only to find such increase followej the. removal of phenobar- that he subsequently needs heavier eedation in bital. order to sleep.Among the patients recovering Well known studies of dream deprivation bar front such drug psychoses in mental institutions suggested that mood find behavior can be banned are physicians, whose self-medication escalated in by significant reduction in REM sleep, and that this manner, starting with an effort to lose weight. a person will compensate with more REM sleep have peopleon drugs as different as barbiturates once the deprivation is over. Thus, tentatively, a and amphetaminesfinally reduced their REM number of investigators hare looked at REM time so that an irrepressible need to dreamex- sleep as one kind of index of the effects of drugs presses itself during waking and disrupts tiejr or alcohol, permitting at least. the loose prediction behavior? that continued loss of REM time Ns-ill have undesirable waking effects. The answer probably lies in the presently un- folding area of neurophysiology, where it is be- Alcohol coming clear that deprivation of REM sleep can Alcohol nt, bedtime does ierl:ed diminish the produce strange effects even incats. Michel duration of REM periods (hieing the first hours of Jonvet and his associates of Lyon, by surgically sleep.(Gresham et a]., 1963). Some years ago, damaging the. Pontine reticular formation in cats, it was speculated that the alcoholic's DT's might have removed from the cats' EEG repertoire the be the hallucinations of waking (]reams, breaking pattern corresponding to Eh? REM phase. These through after years of continued dreamsuppres- cats sleep the sleep of synchronous EEGs but, sion (Greenberg and Pearlman, 1961). A similar unless the damage heals and they begin to show conjecture was made about barbiturate psychosis, the equivalent of :M sleep, they begin to act and more recently about amphetamine psychosis as if they are hallucinating, and eventually they (Kaufman et al., 19G1). die (Jouvet, 1960, 1963). Prolonged reduction of Dexedrine RENI sleep may indeed play a role in the depres- Dexedrine, 'ike alcohol or barbiturates, dimin- sions that often follow in the wake of nmphet- ishes the amount of REM sleep, Dexedrine caused ami nes and in the psychotic symptoms of sustained restless sleep 'n volunteers.It could be counter- used.The psychological loss of dream content acted by coml. ination Nrit ls phenobarbital, Litt the may be somepartof thedisturbance, and amphetamine :ontinued to ..uppress dreaming possibly the suppression of a normally recurrent the. When be same subjectswere observed on EEG phase signirles. as well, the suppres ion of subsequentnights,withoutmedication,they a, normal eledrochemical sequence, a cycle that seemed to eon pensate for the loss, spendingere may pe rlicipate in brain and body metabolisms. time dreaming than they had beforenn baseline The evidence. in any event, suggests caution in 413 43 the use of amphetamines and especially in self- lie in the diffuse projection systems.Thus, the medication. vanished portions of the EEG rest once may help Barbiturates to explain several peculiar phenomena that have A similar caution should apply to the use of been noticed in people under barbiturates. People have shown impaired intellectual capac- barbiturates.Not only have they been shown to ityontests. Habitual users of barbiturates, reduce REM sleep, and in moderate amounts in- moreover, have reported they sometimes lose their voke some intellectual impairment on a behavioral time sense after taking sedation, and will awaken, test , but there is some additional data that suggests not knowing the time nor how many pills they their mode of action in the brain.Drs.. Burton S. have already taken, but will automatically reach Rosner, Truett Allison, and William Goff, used for more pills.It seems likely that some of these barbiturate anesthesia. to filter out (totally oblit- people have been involuntary, suicides.Within erate) one portion of the EEG response that the the banished portion of the EEG response there brain will emit after a sensory signal.In some may also lie a clue to some of the reported afteref- studies subjects were administered an extremely fects of sedationthe so-called hangover.It is mild electric shock on the skinduring waking, still pure conjecture, but not unreasonable to as- through all stages of sleep, and under drugs. The sume that brain activity in sleep plays a role in. individual's EEGs, just after the repeated stim regulating body functions, metabolic cycles and ulus, were averaged so they could be seen dearly the progression of biochemical transformations and then analyzed. Although the brain's response, that occur unceasingly throughout life.If barbi as seen on the EEG, It-,sted only a few tenths of a turates alter this brain activity, they may be alter- second, it combined a sequence of responses from ing at the same time many other physiological different parts of the brain. functions.The. several studies cited here should, First, roughly speaking, came the response of if nothing else, indicate that barbiturates do not. the specific nerve pathways that conveyed the merely induce sleepfor it now looks as if barbi- shock from the wrist to the brain.Then, later turate sleep may be missing a component that in the script, came the emanations from more cen- usually occurs in natural sleep. tral regionsdiffuse projection systems connected Barbiturates are only one class of drugs used in with the cortex. This progression has been ascer- treating sleep disorders.In final analysis a wise tained by data too voluminous for enumeration use of these and all centrally active drugswill here, but it meant the firs, letter, so to speak, in depend upon discovering how and where they per- the EEG script registered the fact that sensory form their action within the central nervous sys- si,gnals were received in the brain. The subsequent tem.It will be quite some time before there is letters signified the activity needed in processing such an assay of commonly used drugs, although the sensory signal into something meaningful many investigators have begun using EEG tech- perception.Under even light barbiturate anes- niques to examine th sir effects.To a great extent thesia, the response of the specific sensory path- evoked potential studies must be performed upon ways was if anything enhanced, but the integra- animals. for only impianted electrodes can reveal tive segment of the response was eradicated. This changes within small, specific areas deep inside the might explain why the EEG would register a pro- brain.Walter Itosenblith and his associates, for nounced response to a touch, yet the person would instance. have used hair-fine electrodes to deter- feel nothing, and why in surgery there is no mine how ehloralose and nembutal affect the motor awareness of pain, although the brain receives the vertex in eats.They would stimulate the pawof signals from the body. Even in deepest oblivion the animal and record the EEG response.The of stage .1sleep the integrative portion of the brain response would he considerably enha',:edby brain's reponse registers on the EEGalbeit later eldoralose. but liminislied under nembutal. A and larger than in other stages of sleep. errvin" literature of such studies, beyond the This suggests that sonic kind of mentation is 0,-- -ope of this report. is beginning to itmease the daring during the deepest natural sleep, which nrammeutatium of ihe pharnelolegi-t s, rntl hope- may not occur under barbiturates.Current st wl- fully will ennui :WOW clinicians to inAo mote fully ies may point to the anatomical loci That areinacri- informed choices. in selecting sedation and anes- veted by barl,it orate anesthe-ia and are thought to thesia for part ioular patients.While basic nen- 50 44 rophysiological and behavioral studies are begin- such reduced desire to sleep that they had been ning to say more about the specific action of drugs, averaging three to four honrs a night for we lover these studies are often inspired by information a year (Kline, 1561).Iproniazid, and other mon- drawn from clinical studies. canine oxidise inhibitors tested since, may enhance the action of scrotonin and the stimulant Antidepressonts norepinephrine in the brain, possibly promoting bedwetting has re- The treatment of enuresis moreefficient.brain metabolism(Murray,in e)attly evoked some interest in the properties of press; Bailey, et al., 19)9). imipramine, an antidepressant.Drs. Keith S. The EEG pattern of normal sleepas roughly Ditman and Alvin F. Poussiant, at the. UCLA_ judged from the hundreds of nights on record Nenropsychiatric Institute, have administered this has become one of the rulers against which drug drug to children' ho were im7orrigible bedwetters effects are measured, and particular emphasis has and found that S5 percent of their volunteers been placed upon the amount of REM sleep. stopped bedwetting. On the other hand, they also Many drm,s suppress REM dreaming. At the became somewhat irascible.This is an interesting same time current studies of narcoleptics,of drug finding.The investigators, believed that imipra- psychotics, and alcoholics suggest that these people mine enabled some bladder relaxation, and there- need a drug that increases dreaming. Before fore greater fluid capacity, but also that it light- therapists can prescribe more dreaming, such a ened sleep, acting as a mi' Imulant, so that the pharmaceutical must be found. child was able to awaken when he needed to go to the bathroom. LSD-25 Two or three years earlier Dr. by Whitman The hallucinogenic properties of LSD-25 have and his associates at the University c_ Cincinnati suggested that it might increase nightly dream- had shown that imipramine 'or;significantly time.In an initial study, using eats as subjects, reduced REM sleep time in adults.In a study of Dr. J. A. Ifobsor of NM found no increase of dream content, under several drugs, the CI' P very REM time.Instead, the LSD had an arousing consistent finding was thatpeople taking im- effect, so much so that it deterred the animals from iprarnine reported a striking number of hostile sleeping (I lobson, 1961). This was a discouraging dreams (Whitman et at, 1961).The irritability result, but it underlined a difficulty that must be of the children taking the drug might conceivably particularly common in research on psychoactive Le. related to the tednetie: of REM sleep.Bin drugs. As more recent studies have pointed out, this does not explain hostile dream content, or t he )10 sage is a critical factor.In small enough doses-, fact tht.t :he drug has an enlivening effect on de- LSD appears to have the dream enhancing pressed patients.The observations suggest that propjlt y that was expected. 0,e. EEG phases of sleep may be regulated by .1. team working at the Columbia University neural centers also involved in invoking moods, School of Medicine has succeeded in greatly in- and that the processes affecting sleet) affect emo- creasing the length of particular REM periods at tional tone as well.If mood and sleep are inter- the height of the drug's action (Muzio, Roffwarg, locked in the same processes, a certain degree of mid Kaufman, 1961),This, was a 1 'man study, activation might generate cheer, although a greater the 12 volunteers were studied over a year. degree of excitation might become in:mitt:A as At first the attempts seemed doubt bd.The dose irritability.The impact of a drug undoubtedly had to bo modified for each individual. This ad- depends upon the initial stale of the person--and jii,Iment sometimes took 10 successive attempts, a depressed person may indeed ry mite artificial and each session had to be spaced long enough excitation in order to t i,e to a normal level, where- after the previous trial so that all traces of tlte as a normal adult or child might be subjected to drug world have worn off. overexctemeni by the same dose. The dosages were very small, ranging between Quostions abort brainam'abolism haw been rble) 0.7:1 meg. per kilogram of holy weight, about raised by the eircels of another antidepressant, t.c) equi v alt,n t of onelive-hundrealt.h of an aspirin. -Ipruniazid." Dr. Nathan Kline of Rock- A few volunteers shooedspee'nentar increase in land State Hospitalbet.,!an testing ambulatory total REM sleep.Otto subject, given his tiny In-Tressed patients with this drug.2.fter a titre amount of LSD, tripled the length of his second the report was made, several such patients had RE,11 period.Several others doubled their first, 45 or second REM periods.It has been postulated pounds that aro produced within the body. By that dreaming may be trig,g-Ted by a neurochem- what chemicals does the body proeuce sleep? ical that acts upon the brain stem reticular and Where are they manufactured and stored? How pontine-limbic systems.Perhaps LSD acts upon do they metabolize.? We might achieve a truly these centers and bears some family resemblance refined control of sleep disorders if we could simu- to an intrinsic dream triggering chemical.Since late the body's own biochemical behavior.To- LSD has increased IZEI sleep in humans, we can ward this ultimate goal, a number of current re- now hope to develop a dritg therapy for people searches have been exploring the properties of who need to "dream morv," perhaps one that can sexhormones,of gamma-hydrox) butyrate,a be used in conjunct ion with the nitmerous hypr rot- metabolite of GABA, and the cerebrospinal fluid ies that we now know suppress REM sleep. of animals in various states of sleep, sleep starva- Durirg the last year another subject, in another tion, or dream starvation. laboratory responded to LSD with an increase in In the early part of our century it was widely REM sleep (Green, in press). The investigator ob- conjectured that sleep resulted from a toxin, per- served that the oe on also showed somewhat more haps ge.ierated by the fatigued body.In 1910, body movement. than usual and more vocalization a "hypnotoxin" was reported by Legendre and in sleep.The. dosage in this instance (300 meg.) Pieron (Kleitman, 1963).Cerebrospinal fluid was truly huge by comparison with that of the from a sleep-deprived dog caused drowsiness and previous study."Underlying the probiem of dose other symptoms of sleeplessness in a normally adjustment to an individual are a host of compli- rested animal while spinal fluid from a rested cated factors, his constitution, his personality, his animal had no such effect.Quite a number of re- metabolism, and many others.The great varia- lated experiments followed, but there was a seem- tion in the human rpulation makes it difficult to ingly insuperable difficulty; animals gave a de- generalize at an early stage of exploration and pressed reaction to injection, whatever the injec- predict. how any specific individual will react to tion contained. The idea that sleep could be trans- a given amount. of the chemical.Similar varia- mitted from a sleeping animal to an alert one by tion has been observed in laboratory animals and some body chemical inami fact nr2d (hiring sleep has recently become the focus of study (Brown was M. general disrepute for some time. and Shryne, 1961). Recently, however, the trick seems to have been Some of the changes in brain function caused accomplished by Drs. M. Monier and L. Hosli by LSD and other hallucinogens have been ex- of the University of Basel, Switzerland. A dia- amined in EEG studies of animals and humans lysate of brain blood from a sleepingrtJ.Thit (Arley et al.. 1%2; Chapman et al., 1902).These sensed sleep in an alert one (Moonie. 1961). are among the studies orering clues to the regions Moreover, a dialysate of the venous cerebral blood of the higher mammal brain that generate hal- from an alert creature produced arousal in a sleep- Incination and may help ns determine how the ing recipient.Since the donor animals were put brain performs as we hallucinate or d wain. Surely, to sleep by electrical st limitation to the thalamus investigations of "dream enhancing ch-micals" and alerted by stimulation of the reticular forma- are bound to increase because of their potential tion', sham stinmlations Nve re used a-. controls. medical benefits and twarisc of the light they may Dialysate of sham st imulat ion produced quite dif- shed upon the nature of the REM cycle itself. ferent results in the receiving animals.This is LSD is a knoNN n llucinorten, but another chem- perhaps a first step in discovering a general ical that can act as -a depressant, reserpine, has hypnotic within tho cerebral blood of a sleeping also hrreased REM time in people although it creature.Dialysis, al'ot'ess of filtering liquid has had ar, opposite effect upon cats (Hartmann, through a membrane, removed the heavy colloidal 1963).Reserpine releases, a natural neurochern- particles fr 0111 the Hoodbut the remaining mix- ical, serolonin, whose possible role in sleep and ture is complicated, indeed, and we are a long wary dreaming. is eilrrellt1:: causing some interest, from knowing which compounds may be the ac- A Possible Hypnotoxin tive ones.Still the search has a great appeal, for In the pursuit of chemicals with special and the isolating of a natural and general hypnotic remarkable properties like dream enhancement -- could help us to unravel the chemical process of there has been a growing interest in some cont- sleep and offer sensitive control over sleep. r. 46 r, In a related vein, Dr. W. C. Dement and his as- particularly sleep-inducing and that lactone may sociates at Stanford University have been attempt- be produced from a known body ch mical by a spe- ing to find a postulated neurochemical that may cial enzyme in the liverperhaps a clue to the trigger the dreaming phase of sleep. A descrip- drowsiness, depression, and even coma that sonic - tion of this work will make more sense within times attend liver disease (Bessman and Skolnik, the context of a section on REM sleep. 1904).Other investigators at Yale University Although scorching the cerebrospinal fluid or have not been able to find it in the blood or brains brain tissue for signs of a particular chemical effect of laboratory animals by gas chromatography, pos- may seem horrendously difficultworse than look- sibly because its metabolism is too rapid (Carman ing for a needle in a haystackthere is a certain and Roth, 1904). (MB, injected into animals, can advantage to finding an effect within spinal fluid, be detected in their breath seconds later. an advantage that does not obtain if the chemical While the controversy overits endogenous is found elsewhere in the body.If substances that origins goes undecided, Gamma-hydroxybuty Late engender dreaming or sleep can Ile detected within will -:ontinue to be the focus of excited study.At spinal fluid, these will be (ILA inct from other body the University of Maryland, Drs. Robert Vidane, chemicals with the same effect.One reason is the Gerald Klee, and Russell Monroe are investigating well-known blood-brain barrier that prevents many its effect, in different doses, or. people.So far substances in the blood from entering the brain. they have found that it produces an EEG pattern The existence of this barrier is well documented, similar to that of chloralosewith a quick ap- but its nature remains something of a mystery. pearance of paroxysmal theta and delta waves pre- Sometimes it appears to be a matter of delay, preceding sleep.Given intravenously, another form venting a rapid exchange from the blood to the of this chemicalsodium 4-hydroxy-butyrate brain.Even when a compound produces its ef- produces sleep within 10 minutes. in France, the fectsleep, or dreamingafter direct injection compound has been used as an anesthetic in many into the brain, there remains some question about thousands of people, but in combination with mor- the form in which it naturally works in the body. phine or other analgesic. Chemicals in the body can undergo a chain of trans - An anesthetic with no hangover can be a mixed format ions with lightning speed : Does the injected blessing.When the drug has worn off the animal form of a chemical act directly upon the brain or person will quickly awaken, and move around. cells, or is the effective chemical some metabolite? He will not show the sluggishness caused by bar- This prelude may outline the background of a con- biturates. On tile other hand. the groggy after- troversy that surrounds one of the exciting new math of the barbiturate may dull the experience of compounds in the realm of sleep. pain.After 01111 anesthesia, the pain occurs rs Gnmmo -hydroxybulytate I fly as awakening, a reason for administering all analg sic. Gamma-hydroxybutyrate may he calledthe center of the interest, one of a family of st Latent r- LEG studies with animals have indicated why ally related compounds that have been shoe n to these two kinds of anesthesia produce slch dif- produc,3 REM sleep, or paradoxical sleep as it is ferent effects.'1 he clue can be seen in the brain- known in animals.It has been used as a wave response to a dianthus.During barbiturate thetic and has no hangover effect, and is being in- anesthesia the cortical or integrative part of the vestigated as a possible "hibernation" drug for EI:(4 response is o'ffiterated, although the re- man in :.pace.It i3 related to a naturally occur- st repre,outing reception of sensory signals ring body chemical ((lamina-amino-butyric-acid) ritually appears enhanced.Under barhiturates, GA BA, and controversyages about the ques- it would seem, the sensory signals get into the tion : Does this chemical, or its lactone form, exist brain but are never transformed into perception. in the brain or body organs in enough quantity to 1n,ler 01111 or related compounds the opposite become a natural hypnotic ?The answer may be seems to (went..The sensory signals do not seem that it metabolizes so rapidly that it is generated to enter the brain and the integrative functions re- only on demand.Ihs, Samuel Bess-man and main moliminished.Thus, the one appears to de- Sandra Skolnik at the University of Marylat press functions necessary in ilWarkficz, the other have found that injection of the lactone folin is to censor the actual inpat of the senses..

47 Herein lies the key to some of the excitement Ell sleep may tell whether the overall effect is that about this new family of chemicals.Unlike, the of natural sk). barbiturate, it leaves imegrative-cortical func- The ideal of course would be a drug that per- tions intact.Judging from EEG responses, it mitted ns to p:oduce sleep in the same way the would seem to produce an effect in the brain that body does.There are many reasons for suspect- is congruent with the response pattern of REM ing that th3 body I riggers sleep biochemically, and sleep.Lie EEG responses give the signs that it the search for these chemicals is not at all new. inhibits sensory input, without diminishing inte- There have been attempts to find a hypntt ie chem- grative functions.This is exactly the kind of ical prodnced by muscular activity, by wastes, EEG response pattern observed many times by many attempts based upon the logic that one many investigatorsinsubjects during REM should find a "fatigue." substance generated by (paradoxical) sleep.The property of censoring waking activity.These attempts have not yet incoming sense signals while leaving integrative succeeded, and today experimenters have begun functions alone may be an important. attribnte. in to think that they may not be searching for just any hypnotic that will not suppress dreaming. ono substance.There might be several chemical Experiments with gammalmtyrolactone have mechanisms stemining from different metabolic shown that it will induce, paradoxical sleep in cats. chains, having different effects even thongli the net This finding about this chemical and some of its results might look like the same behaviorsleep. related compounds has prompted considerable Recent experiments begin to suggest that indeed study.In point of fact, the studies began several slow-wave sleep and REM sleep may be influenced, years ago in Lyon, in both acute and chronic cats. and perhaps triggered, by totally different chem- In an acute experiment the procedure nece.ssarily icals. terminates the life of the animal, whereas the so- The suspicion that two different chemicals may called chronic animal may be observed in the lab- trigger sleep and REM sleep has been phrased inoratory for weeks, months, or years following 4he formally for several years, and itis heightened experimental procedure(Jonvet, etal.,10G1). by evidence from the diverse. researches of Dr. More recently acute experiments of the same sort Michel Jonvet, of Lyon, France, and Dr. Werner have been performed in Tokyo (Matsuzaki et al., Koella, of the Worcester Foundation feu Experi- Intravenous injections of sodium butyrate mental Biology, in Shrewsbury, 3Iass. and related compounds were used to induce para- Reserpine doxical sleep in cats whose brains had been tran- The French researchers have looked closely at sected at the ineseneephalon as well as in intact ani- the sleep of cats following an injection of reser- mals. The chemicals elicited paradoxical sleep in pine. This compound is a derivative of Itatiwolfia cats with midbrain t ransect ions, as well as in intact or snakeroot, an ancient Indian remedy that has animals. been used extensively in modern font-1 to calm Whatever its usefulness as a tool in deciphering people in slates of intense emotional disorder and the mechanism of REM dreaming, this new family to lower blood pressure in hypertensives.Reser- of compounds holds great promise as a hypnotic pine reduces slow %vare sleep, and its impact upon that does not depress REM sleep.Indeed, its the paimloxical phase of sleep in eats might be extraterrestrial value may cause more study than said to re,--enilde After a siii.de its potential usefulness here on earth.It appears injection of reserpine, pradoxical sleep would Be- to be one c andidate for producing hibernation dur- eline, disappearing altogether for :1 days.This ing I,-mg space flights.If there is to be such a rrtnnshatdo effect strongly sugwsted that re -c1.- thing as druginchieed hibernationfor space pine odot inactivate brain centers or brain chem- travel or medical purposes, surely today's evi- icals that are essential to paradoxical sleep. dence indicates that the drug F110111d not cause Veserpine is known to reduce the c,ou en: of REM i(.5Space scientists have been investi- serotoniii in the brain and to allot other brain gating 1-hydroxylnityrale. The cnnipmnri A number of the-0 cliomicalA itS a SI;f11111C1111 drop in I.,,ly sub,-evently administered to det,,Imin,, 3'--which is greater than the hortnal nightly de- they counteracted the11111):1ciof re,erpink, on cline.At the slit& time, oxygen consumption is paradoxical sleep. A cat Av;ISI.Tiven roserpine, and decrea:sed.Studies of humans in prolonged 4- then an injection of :.hydroxytryptophane (',- 48 4 HTP). This is a substance known to precede experimenters found it curious, however, that the serotonin in the metabolic cycle.Serotonin is 5- same chemical first produced an arousal response, hydroxytryptamine, and 5 -IITP is a substance and wondered if they were seeing reactions from from which it is built. An injection of 5-IITP two distinct portions of the brain. should have restored serotonin in the reserpine- This hunch was borne out by the experiments injected cat.If an increase in serotonin were that followed. Tha brain stem of a cat was surgi- crucial to paradoxical sleep, then it should have cally transected so that the effect of serotonin was reappeared.Not. so. The cat now showed a nor- only apparctt on the anterior portion: now the mal pattern of slow wave sleep but. not a sign of animal showed the brain v ,awes of arousal but there the paradoxical REM phase.I Iowever, if the shot. was no sleep.ibis implied th^' serotonin was of reserpine were followed by an injection of dopa, inducing sleep by affecting the posterior brain REM sleep did reappear. stern, at the very base of the brain.The experi- Dopa menters began exploring a very small structure Dopa is a precursor of noradrenalin, a sub- at the base of the brain stem, the area postre ia, stance produced in neural tissue throughout the which miglit be described as a gateway region to body and brain.When dopa was administered the central nervous system. When this small area to a cat that never received reserpine its afect was was destroyed in cerehellectomized cats, the sero- striking.Given to a normal cat, dopa increased tonin injection continued to cause arousal awl not the animal's paradoxical sleep. However, if a nor- sleep. The researchers now zeroed in on the area mal and mmedicated cat were give:. 5-IITP in- post mina. stead, its paradoxical REM sleep was depressed. This region has been known to accept serotonin This series of findings suggested that paradoxical and other similar chemicals, i.e., it has no blood- sleep might be dependent upon chemicals related bra in barrier.It now seemed to be the specific to adrenalin and noradrenalin, but not to sero- neural receptor site on which serotonin acted to tonin. facilitate, sleep.Instead of surgically destroying the area postrema the experimenters took their Serotonin next step to nullify the action of serotonin here by Serotonin would ai,nr to play a role, in pro - chemically blocking the receptor site and thus ducing slow wave sleep. As usnal, in science, a long preventing the sleep response. D and other history of researches into the cticots of serotonin on chemicals block the action of serotonin, which is a blood pressure and nc.ny brain functions preceded neural transmitter.When one of these blocking the studies thct implicate serotonin in slow wave. agents was applied to the area postrema an in- sleep (Koella, et al., 1900 r,1901,1903, l9t15; Koella, jection of serotonin caused the EEGs of arousal, 1903). In recent recarches the investigators no- but not sleep. On the other hand, whenever sero- ticed that serotonin was producing some peculiar t (min was placed in the area post rema of an intact effects on lorainwaves (Koella et al., 1905). When cat the EEG's gave only the signs of sleep, not injected into the carotid artery of an immobilized arousal. or anesthetized cat, serotonin promptly produced Serotonin seemed as likely candidate as a body- an arousal reaction.This brief EEG aton=al pat- generated chemical that induces sleep.Sure- tern was then, followed by 15-20 minutes of slow ly if a body Acrid( al were responsible for inducing W;INTS and sleep spindles, and the large spindling sleep one might expect it to act at the base of the EEG pattern known as a recruiting response, brain near the spinal cord. There is one interest- The recruiting response has drawn interest be- ingfact,however. Serotonin does notpass cause it may he related to the normal EEG spindles through the blood- brain harrier.Thu.: itcould seen in sleep. Experimenters have found that they not directly reach nith its effects deer into the. could obtain this EEG recruiting response by eke- brain stern. An exploration oflie area post rema, t rioally stimulating the medial aspects of the tha- where serotonin is received, may however expla n lamus. Sleep has also been produced by :timid:d- how serotonin could cause a hypnogenic response ing This same thalamic region (Akert, et al., 19J`!). in the re.-t of the brain. The area postrema is con- PI, ['hap: it is not surprising that an injection of a nected by dendrites to an adjacent area within the chemical :night produce both the EEG recruiting brain, lIme nucleus of the (nicht: solitarius which respons.. and brainm ayes typical of sleep.The is probably not directly permeable to serotonin, 49 but may receive its effects through the dendrites convulsions. By administering finely graded doses linking it with the area post rema. they hope to determine whether stet lids will pro- The action of serotonin as described here may duce sleep in the amounts secreted by the body. illustrate what is often referred to as the triggering A connection between sex hormones and sleepiness actionor triggering chemical. Serotonin may aet should not seem surprising, for it is observed fre- as a neut ral t rigger. It stimulates receptors within quently without any reflection, in the aftermath the area postrema, which, in turn, stimulates cells of lovemaking, people, tend to fall asleep. in nn adjacent nucleus tractus solitarius, perhaps Hormones appear not only to elicit sleep, but causing it neutral chain reaction whose consequence perhaps also to change its quality by influencing we know as sleep (Koella, et al., 1965). the EEG phases and duration.Drs. Ling and The indication that serotonin can induce sleep by Heuser have observed that cats sleep a good deal its act ion upon a brainstem structure does not elim- longer given progesterone, than if they are sedated inate the possibility that other body chemicals also with compounds that resemble the neurochemicals participate in producing natural sleep.Serotonin serotonin and acetylcholine.Moreover, the sleep is chemically like a hormone, and acts as a neutral induced With progesterone is distinguished by 1 r.insinitter over very short distances.Other in- ample episodes of paradoxical sleep.In studies vestigators have been looking at the effects of sex of eight pregnant cats they found that the inci- hormones for an elucidation of the natural sleep dence of paradoxical sleep increased as pregnancy process. progressed toward delivery, and during the brief Hormones poet paritun interval after delivery the cats also Unnatural sleepiness, or at any rate excessive showed frequent periods of paradoxical sleep. sleepiness, is the accompaniment of numerous dis- There may indeed be some truth to the old wives. orders, but also occurs in normal people who are tale that a woman dreams a lot when pregnant. undergoing changes in body chemist ry.In a book The story does not seem to he a simple one, how- called "Pregnancy and Birth," A. F. (Intim:teller ever, and an increase of progesterone should not has described one of the most common of sleep dis- be expected to produce an orgy of dreams. Under orders."In some women, one of the earliest signs some circumstances it may (1.5 the opposite. of pregnancyisanoverpoweringsleepiness. Enovid, a combinatiou of a progesterge a deriva- Sleeping late in the morning and napping in the tive and an estrogen, both female sex hormones, afternoon do not prevent the pregnant young wife prevents ovulation.One sign of its antifertility from yawning in her husband's face and from doz- effect has been that it delays or suppresses signs of ing even at her own dinner parties.This excessive dreaming normally seen in a female rabbit just fol- need for sleep disappears after thefirst.few lowing coitus.Ordinarily the fertile rabbit will months." Although the soporific serenity of a quickly lapse into sleep, soon showing EEG signs prerant woman bears no resemblance to the of paradoxical sleep, but if her production of blankneiss of an epileptic seizure, or the catalepsy ovnlatory hormones has been blocked, the familiar of a narcoleptic, the catatonic state. of a schizo- EEG patterns of paradoxical sleep will not occur. phrenic, or the anesthesia state, there may be a This index of fen ilityand method of quickly de- chemical link between them.Somnolence, anes tecting an ant lien ility compoundwas discovered thesia, and convulsions may all be produced by by Dr. Charles Sawyer and his associates at UCLA differentconcentrationsofprogesterone,the as they explored the relation let ,vecii the sex hormone secreted in large quantities by pregnant steroids, bra in act ivity, and fertility.I fere, para- woman.Progesterone, indeed, is only one of the doxical sleep played the role cf a key into the hormones known to produce an anesthetic state, brain processes that govern sexual behavior and and some have been used as an anesthetic. reproductive capacity (Kanenmtsu and Sawyer, Drs. George M. Ling and Gunnar Ileuser are 19(13: Kawakami and Sawyer, 1959, 1962; Sawyer, currently collaborating at UCLA nn a curdy of the 1901,1963). effects of several steroid him mones on the central The solution to the world's crushing problems nervous sy;.t on.They have shoran that Imo pre- of overpopulation may hinge upon onof these curiirs; of hormones (dehydreepiandrosterone, recent discoveries about the neurochemistry of fer- and II desoxycon isol)will produce sedation in tility, among. them the riffling that Enovid and Inn dos:ngcs, while high doses invoke seizures and other steroids that block ovulation act upon the SO 56 central nervous system. The impact of steroids important and as yet unanswered questions about on ovulation had to be reinterpreted in the early the influence of hormones on mond and sleep. 1060's when Drs. Sawyer and Kawakami knit to- Quite beyond supplying an index hi which anti - gether their diverse findings on many species, ovulatory drugs can be screened, the paradoxical showing, among other things, that these com- sleep of the postcoital rabbit has instigated many pounds depressed the likelihood of paradoxical assays of sleep pat terns and hormones. Dr. Kawa- sleep following sexual stimulation.Rabbits were kami has shown that an animal going into estrus used a great deal because they are reflex ova- has an increasing ratio of paradoxical to slow- lators; that isovulation is induced by coitus, wave sleep. Female rabbits, given the male hor- whether real, artificial, or performed by brain mone, testosterone, will not show paradoxicalsleep stimulation. The characteristic afterreaction to after mating, nor will the normal male.But a coitus is unambiguous, even without Eli Gs, for castrated male, given the female hormone estro- in slow-wave sleep the rabitt's ears remain erect, gen, will show this sleep symptom followingelec- but when paradoxical sleep begins they suddenly tricalstimulationof the septum (Kawakami lose muscle tone and droop.This reaction was and Sawyer, 196 ).What is the relation between probed by the injection of pituitary' hormones and the ses steroids and paradoxical sleep?Do they by direct stimulation of the hypothalamus, which suppress dreaming in human beings?Could ste- could produce the rabbit's efterreaction.In tests roids and other antifertility agents act upon the of niany hormones and other conipounds, it be- lateral hypothalamus to affect mood and incur came clearthat barbiturates, the tranquilizer subtle pets( nality changes? chlorpromazine, and morphine had a pronounced Further explorations in this direction may help effect upon the afterreaction of the rabbitsug- to explain emotional differences between the sexes. gesting that they nay block the nervous activatioit Moreover, they may help to explain psychological of the pituitary gland in releasing ovulatory hor- phenomena that are clearly linked to sexual peri- mones. In this regard, it is interesting to note that odicities, such as the depressions and exhilarations morphine addicts send to be infertile, and female of women at the onset of menstruation and during addicts generally have irregular menstrual cycles. the postparturitional days. In pilot studies with In a long series of studies with various tech- cats, Dr. Sawyer believes he has seen cl angesin niques, using steroids directly upon the brain or temperament after hypothalamiclesionsthat surgical lesions in the hypothalanins, it became block ovulation.Patterns of sleep, showing us clear that the brain certeis controlling sexual be- something of the integration of the nervous system havior and those controlling pituitary hormonal by which we can compare normal and altered function were quite discsetc in the rabbit and sex- states, have provided a new tool for whatpromises ual behavior could be independent of influences on to be an even more important skein to unwindin fertility.Thus, the brain seemed to contain a fer- a world where fertility islikely to be controlled tility enter, sensitive to steroids, which would with drugs. induce ovulation after elee'rical stimulation, but No extensive EEG studies have yet been con- if damaged, mintid cause gonadal atrophy.The ducted upon preplan', women, or women taking location of this center (the posterior basal hitter Enovid. The widespread testing and use of Eno- of the hypothalamus) in a brain legion known to rid for birth control, and, in higher doses, for the play a large role in emotion, may enable its to treatment of it pelvic disease associated withinfer- determine how emotionstmod, anxiety, and tility, have enabled clinicians to observe some pay- stress, affect fertility.If stre=s hormones, and cliological effects.:tfarty women have discontinued ueurolnimors of emotion act upon this region to the use of Enovid because it makes them feel de- block fertility, we may learn low to treat sonic pressed or irritable. When heavy therapeutic of the perplexing cases of sterility for which peo- tried for the imposes of advancing ple seek clinical aid. A ela'-sic in titmice of what do -es were seems to be "emotional- infertility is that of the fertility among wives of armed services personnel, Couple who cannot conceive, hit who do, indeed, temporary psy-hosis occurred in about 4 percent. begin producing children silently after adopting these symptoms could 1T det&terl or even a child. anticipated by changes its EEG sleep patterns- is The txplorations outlined so s,.antily heir, taise still an open question.

57 51 We have known for almost, a decade that sex dueed at nerve ends in the body and brain, and ap- hormones can act directly upon neural. tissue. pear to play an important role in transmitting Ifowever, nobody will forget the startling demon- nerve impulses from one cell to another.They stration that a male hormone, placed within a appear, additionally, to play an essential part in particular brain region, engenders the confusing the homeostasis of the body, maintaining the equi- result of maternal nesting behavior in male rats librium of the autonomic nervous system, stabiliz- (Fisher, A. E.).So we have, by implication, the ing heart rate, or stomach motility. problem that we are not just dealing with neuro- Dr. Ling postulates that these two chemicals chemistry as we explore hormonal effects, but also play a homeostatic, or a balancing role within the anatomical organization and the responsiveness of central nervous system as well.Noradrenalin is specific areas to specific chemicals. Do steroid hor- related to dexedrine, one of the amines of the nerv- mones mitt...ally act upon certain brain regions ous system that promotes alertness, and arts as a or do steroids act as a trigger for other brain psychic energizer.In excess, this amino may also chemicals? The EEG patterns of sleep are being bring anxiety, restlessness, and the mental states used in researches to answer this question. associated with insomnia. On the other hand, as A great many factors have encouraged the sus- he has demonstrated kith cats, acetylcholine pr. picion that the sex hormones play an important, duces somnolence in the Panic) brain sites where role in sleep patterns, in mood, and in dreaming. noradrenalin evokes arousal.Perhaps this ace- The fact that adults begin to show a decline of tylcholine, in '::ergo concentration, invokes apathy REM sleep after age 40, is in itself suggestive. A and even depression. These two chemicals may be recent study of the sleep of five women has added natural components of sleep and arousal, and to this evidence.. Women undergc cyclic hormonal small increases in their concent eat ion might trans- fluctuations, marked by menstreatioh, and also by form mere arousel into acute anxiety and turn variations in mood that are so severe in a small per- sleep into depression.Such speculations are em- centage as to approach mild psychosis and demand phatically tentative at the moment, but they are medical aid.If hormonal changes were reflected bound to provide a rich inspiration for research-- in sleep, one would expect to Pee cyclic changes in for they suggest techniques by whieh we may dis- women. In an initial study, changes have, been cover the close bioclue ideal ties between sleep, hor- observed, especially in increases of tircain time fall- mones, and mental illness. ing toward the middle or end of the monthly cycle Right now, anyway, it looks as if there are two (Hartmann, 1065).Curiously enough, these pe- major chemical systems at.. work in causing nervous riods of higher dreaming coincide with periods tissue to perform. The eh& inergic system may be of anxiety and somet inter depression. inhibitory.In other word, acetylcholine nay be Dr. David Hamburg and M. Dallman at Stan- the neuroehemical that excites brain cells that ford University Medical School have been inject- game sleep, or the ..es.ait ion of an activity, but this ing progesterone directly into the hypothalamus inhibitory 1% orb: does not go on infinitely, because in rabbits, but analyses of brain tissue have not another chemical, cholinesterase, acts like a brake yet, revealed whether the hormone acts directly on halting the potent. action of acetylcholine.Cells the brain. Why would hormonal levels affect instigating arousal, or other specific excitation, sleep, and even indu ie sleep, if they do not act, may be activated by the neural stimulants of the within tha brain? adrenergie systemenoradrenalin and aductialin. Acetylcholine and Noradrenalin Presumably these also have a cheini.ed brake, hut A number of investigators have speculated that little is known ;thout, their metabolism at present. substances such as horn-pales affect the levels of This is a vastly oversimplified view, yet it may Pro- two important brain amines which do, in turn, vide a kind of primitive map to some of the basic produce sleep or arousal.Cuerent research by research currently probing relationships between Drs. Ling., Fisher, Hernandez Peon, and numerous sleep and mental illness and their biochemical investigators in other areas of neurochemistry may nature. slnx us that the brain operates cn a chemical cock, Sono investigators have keen systematically and that two of its principal cxle chemicals aro probing a pa ri i,:nlr region of the brain.Dr. acetylcholi no and noradrenalin. These aro found Natl,,i lief lieehwahl and associates at UCLA, throughout the nervous see-ten They aro pro- for instance, latvo been tinntlating one brain cen- 52 i8 ter and charting the associated behavioral changes reticular activitya passive state, brought about and EEG patterns at other sites in the brain by default so to speak.Today, however, sleep (Heuser et al., 1001). This is an anatomically dis- does not look like the consequence of a lack of tinct island, located under the cortex, in the fore- activity in the brain, but the result of activity part of the brainthe caudate nucleus.Here is within a specific neural system, a system that the largest supply of cholinesterase stored in the actively inhibits arousal.This was the assump- brain, a braking chemical for acetylcholine and tion on which Dr. Hernandez-Peon and his asso- the nervous activity it incites. 1Then cholinester- ciates set to work, at a time, it should be added, ase is destroyed in this area and electric stimulation when mho outcome was quite uncertain.They is gently applied, the animal suffers tremors or sought to locate a topographical map, if possible, epilcptiform seizures.Because the caudate nu- sho\\ing where 11111.1 perhaps how the brain cleus is one of the brain's largest storehouses of produces what we know as sleep. important chemicals, among them dopa and dopa- Although they set out, using brain stimulation mine, it may offer some clues about the neuro- as their main experimental probe, on an expedition chemistry of parkinsonian tremors, epileptic fits, to map the uncharted sleep system, and were no and schizophrenia. primarily interested in its biochemical properties, Chemical Brain Mapping they came to rely heavily upon chemical stimula- Following another approach, some scientists tion.One reason was the diffuseness of electrical have been using acetylcholine and noradrenalin stimulation.Ii a pulse were delivered to neural directly upon the brain, in a manner analogous to cells within a particular systern it might cause electrical stimulation, thus learning which brain acLivity among cells adjacent but outside of that systems respond toeholinergic chemicals and syinem. Any neuron might be activated, inad- which respond to adrenergic stimulation. The vertently.for refined brain mapping, then, psy- implement, chemical stimulation, has had an ex- chologists and neurophysiologists wanted a more tremely important impact upon our understandieg selective method, a stimulus that would spark only of the anatomy of sleep. the cells involved in a particular activity.They Using brain chemicals as his probe; Dr. Raul tried using the chemicals known to modify syn- Iiernandez-Peon, and his colleagues, working aptic transmissions in nerves throughout the body, largely in Mexico City, have shown that sleep is among them, acetylcholine and noradrenalin. promoted and regimlatcd by a large system of brain Animals were implanted with fine electrodes for cells, sweeping from the frontal regions gown to EEG recording and sometimes for stimulation or the brain stem with centers in the thalamus and the creation of small lesions.Similarly they were cerebellum.During the last decade the-,e was a implanted with;inecanwille,hollow guide- growing confusion about the brain centers that, slut fts through which a tiny chemical crystal could upon stimulation, caused an animal to sleep. be tamped to the nerve cells.Like electrodes, There were so many of them--electrical stimula- these cannulae could be left in place comfortably, tion in the frontal regions, or caudal legions, in the and the experimental animals had freedom of thalamus and hypothalamusand all scented to movement and a relatively normal laboratory invoke the well-known EEG pattern' and behav- existence.. A fine screw threatiing would permit . ior of sleep.This electrical brain mapping had the experimenter to stimulate a locus, and move begun with the pioneering work of W.11. Hess of the commula a millimeter at a time through seven Zurich, who had produced eating, rage, and other depths of tissue, behavior by delivering mild electrical pulses to the Cats Were the primnry experimental nriiinal in brains of animals.Electrical stimulation of the mapping, time sleep sstem, Mid acetylcholine has brain became a valuable tool and was widely used. been the chemical that stimulates hypnogenic cen- In their memorable experiments of the late ters in this animal, innting it to sleep.Species 1010's and early1050's, Morezi and :Magoon differ, however; if you stimulate a rot brain, in excited the world of brain research with their dis- roughly the same pathway that elicits sleep in cats, covery that stimulation to the reticular formation acetylcholinewillevokethirst and drink:rig led to arousal and wakefulness.Hero was evi- However, apply noradrenalin to certain parts of deuce of an arousal eel .t er in the hrein, the rat brain, comsponding to the regions in enough, sleep was considered to be the mere lack of which acetylcholine produces sleep in catsand

5;) 53 noradrenalin evokes sleep in the rat(Fisher, fall asleep in 15-30 minutes. When acetylcholine 1961). was injected into the preoptic region of the hypo- The hypnogenie response of the cat to acetyl- thalamus, a waking cat fell asleep in 2-5 minutes. choline ws supported by a few simple experi- The same stimulation to another hypnogenic area, ments.If the animal were given atrophic, or m- however, caused sleep fa e2 seconds. other chemical that blocks acetylcholine, then elec- Films of this stud3 convey the instantaneousness trical stimulation failed to produce sleep in the of the effect. A cat, in the midst of eating; re- very spot where it had formerly evokedsleep. An ceived stimulation in the sleep-circuit, and liter- animal, put to sleep by several brief electrical ally fell asleep so fast that his head dropped into stimulations to a brain locus, then injected with his food dish.Speed of sleep onset varies with atropine, remained wakeful through repeatedelec- the region stimulated and so does the length of trical stimulation.Presumably, the missing ele- sleep, One locus produced a sleep that generally ment was the blocked, biochemical action of lasted abodt 30 minutes, yet another produced acetylcholine (Ifernandez-Peon, 1963). sleep lasting as long as 4 hours.One locus pro- Nerve impulses can be stimulated by electric duced a sleep so profound that the animal could shock and detected by electric sensing devices, but not be awakened by noise or pinching, only by di- the nerve impulse itself is not like an electric cur- rect stimulation of the arousal systeen.In all of rent passing along a wire.Rather, it results from these instances the sleep included the natural 1,7EG a biochemical change in themembrane surround- phases, both synchronous sleep tied paradoxical ing a nerve cell, a movement of ions, electrically sleep.This suggests that the subjective quality charged particles that follow the release of a chem- of sleep, the rapidity of onset, even the length of icaltransmitter from a neighboring neuron. time we sleep, may be related to specific points ElecZrical stimulation, therefore, causes biochemi- along the hypnogenic path. cal action.It is not like feeding current into an The term "pathway" suggests a narrow route, a electronic machine. The electrical stimulation roadway, differing from, the terrain on either side, that was producing sleep most have caused a re- This is an appropriate connotation, demonstrated lease of acetylcholine at the synapses of the sleep by repeated experiments.After chemostimulat- neurene, a release that was blockedby atropine, ing a particular site in an experimental animal, the with the consequence that acetylcholine no longee researchers would wait for the cat to wake up and acted as a biochemical transmitter and the sleep bewne fully alert. Then they moved the eannula neurons were no longer activated. a millimeter or two and repeated the stimulation. Using acetylcholine and electrical probes, in This time the chemical did not elicit sleep, but countless experiments on hundreds of eats, it was sometimes a very different kind of response,The found that there was indeed a hypnogenic path- acetylcholine that evoked sleep from one set of way, beginning far forward in thefrontal and neurons aroused totally different activity within temporal lobes, with a center in the thalamus, and neurons not 1 millimeter away. extending downward toward the spinal cord. What has emerged from this extensive program Lesion experiments demonstrated that this cholin- of chemical brain mapping? Now, instead of is- ergic pathway lia.s both an ascending and descend- lands of brain cells, inexplicably scattered, we see ing route.Messages are borne downward from theme is a whole pathway, shaped somewhat like the cortex and frontal brain regions to the brain a sickle, within the subcortical regions of the brain stem, end also upwards from the spiral cordin- that produces sleep with cholinergic stimulation. hibiting the vigilance system of the brain stem. It is connected, by fibers, with the cortex, that (I (erne ndez-Peon, 1963). outer layer of cells involved in thought and the Most people have noticed that all sleep is not refinement of perception and emotion, from alikeit occurs faster on some occasions, like the whence the voluntary commands to sleep may sudden dropping of a shade.It differs in quality. arise.It is connected with all the sensory modal Some of the experiments suggest why this may ities, and current exploration of the ascending be.The same crystals of acetylcholine, touched to pathway may explain bow repetitious rhythms, different brain sites, produced sornewlist different like patting the cat, may put it to sleep.Depend- results.Ordinarily, if a cat is placed in a labors- ing upon where the circuit is touched, it produces tory cage and left alone, it will settle clown and sleep of different duratio:-. profundity, and qual- 60 34 ity, whim may help us to explain the different might conceive that the positive motivational sys- kinds of sleep we experience, out of boredom, after tem is connected with neurons producing sleep. intense athletic exertion, following pleasant or On the other hand, negative motivation seems to wretched emotional experiences. A further find- be connected with arousal, and indeed, a so-called ing may help to explain the restless sleep or in- "aversive" brain center, one producing negative somnia, that often occurs during periods of great feelings, has been located in a region that anatomi- worry. cally overlaps with the arousal center (Hernandez- During one study it was found that a spot Peon, in press). evoking sleep with acetylcholine would produce These geographical findings do not explain in- an arousing effect if touched with roradrenalin. somnia, but they permit a hypothesis. When Other chemicalsGABA, adrenalin, nialimide emotional excitement is intense, particularly when were tried but had no effect.Within this region people worry, they cannot fall asleep easily.If the sleep path may come into close contact with this situation becomes prolonged, it may indicate the arousal system, perhaps overlapping or fol- that the arousal system is overactive, triggered lowing the same route.Current experiments will into excitement by the emotional excitement in the explore this possibility by using noradrenalin as limbic area nearby.There may be a very different the stimulus. Once again there is the suggestion explanation for the insomnia some depressive of a dual chemical code in which cholinergie com- and elderly people who cannot manage to stay pounds affect sleep- evoking cells and adrenergic asleep the whole night through.If some metabol- compounds excite the cells of rl,n antagonistic sys- ic failure left the hypnogenic system without an temthat of arousal (Cordeau, 190). adequate supply of acetylcholine, then it might The anatomical evidence for a relationship be- run out of neural fuel, so to speak, and be unable tween sleep disorder and emotion does not yet ex- to inhibit the arousal system for a full night. plain insomnia, but it suggests some good topo- These are conjectural explanations at present, but graphical reasons why negative emotions might they have considerable importance for therapy. affect. sleep. If we are to treat patients with insomnia or other "Motivation" and Sleep sleep disorders to their greatest benefit, we must Brain centers, colloquially known as "pleasure tailor drugs to the specific needs.These anatom- and pain" centers, have been located by electrical ical findings suggest means of testing drugs for brain stimulation, beginning with the discovery their effects at particular loci in the brain.They of Dr. James Olds in the 1950's of a point in the may aid investigators Nrho are now beginning to hypothalamus that gfiee appearances of pleasure look at ding impact through evoked potentials and in the animals stimulated there.If motivation is other neurophysiological and behavioralpro- determined by the "sense" of reward or punish- grams. Mappings of the sleep and arousal systems ment, or more neutrally, the positive or negative continue, and as we begin to acquire ft more refined reinforcement that accompanies a behavior or chart of systems within the brain and the chemical thought, this center was indeed a motivation point. code that activates them, we have the prospect of It appears to transmit impulses through fibers developing specific remedies, offering needed sleep that pass through the medial forebrain bundle. without hangovers, side-etTects,depressions of The sleep system also transmits through this fiber mood and without actually exaggerating time im- bundle.This might suggest why pleasurable balances from which sleeplessness or disorder sensations often are accompanied by sleep. We originated. 61

55 I have seen Hamid Bey, when under medical examinations by a commit- tee, extend both arms and ask two of the physicians to examine the pulse at the right and left wrists respectively. At the same time a third physician would take his heart beat IT means of a stethoscope.At first all would report the same rate, say 72 to the minute, then Ham& Bey would begin to concentrate.At the end of a minute the doctor holding the right wrist would report 64 to the minute, the doctor holding the left wrist 96 to the minute, while the doctor listening to the heart would report 84, all at the same time! Another demonstration which Hamid Bey gives of his unique powers is permitting Cie flesh or tissues of the body to be pierced with long pins or daggers, seemingly without pain.. .. Hamid Bey will ask whether it is desired that Mood will flow from the wounds, and he permits it to flow or ref uses, at will. However, his demonstration of body catalepsy i8 the most remarkable of all.His body becomes rigid, the pulse almost imperceptible, and respiration apparently ceases entirely.Consciousness is said to be obliterated and nothing is remembered of the time spent in that state.In this mental state Hanzid Bey permits himself to be buried under ground, with or without coffin. ... Newspaper Reports of the 7.920's By many scientists and students 1 am, considered to be an 'unusual or super-man. ... 1 am a very ordinary person..fly ability, unusual as it may be, is entirely the result of work and efficient training.Under similar circumstances, any ,normal person might have accomplished as much or perhaps more than I. Ifamid Bey Chapter VI. Control Over Sleep and Other States of Consciousness Singular feats of mental discipline and bodily River in an air-tight coffin in the 1020's, lloudini control have marked certain individuals through- followed suit in a debunking manner, inspiring out history as almost superhuman. More admired 13ey and others to a contest of live burials. than outdated, these incarnate gods have received But the secret, was training.For centuries yogi their most rapturous worship from the ignorant have practised, under the name of pranayama, or from children.They have been the yogi, disciplines of restricted breathing among their calmly seated on bed of aa i is, or the Iroquois hero, many exercises, for which there a re about 81/2 silent and stole (hiring a savage beating, or the million variations.The purpose Is not a freakish remarkable swami, standing on his head for hunts prowess, but an integrated control of body and at a time, inert as done in contemplation. The mind. allowing, the indi:idual full access to his com.nercial exploitation of these skills has leil conscionsness. ninny adults to suspect that all fakirs indeed, !mist Many eastern religious, among them Zen Bud- be fakes, for their performances seem beyond dhism, provide rano-ems with training in intro- normal human attainment. When Rahman I3ey spection and mental control, yet their goal of en- spent 40 minutes at the bottom of the Hudson lightened peace with the universe has seemed 56 62 diffuse, appealing less to Westerners than combat learn, yet masters maintain this position for 7 and tactics of jujitsu, karate, yogi acrobatics, or mus- 8 hours.While meditating they may give every cular relaxation procedures.These skills may appearance of being asleep, yet they are in a state seem more attainable than some of the supreme quite different from sleep.There is an anecdote but subtle skills that have elevated our heroes. about Dr. Baisetz Suzuki, a great Zen philosopher, President Kennedy, for example, was being fitted as he attended a conference on Zen and Psychoanal- for legend during his brief term of office, as people ysis.A. guest of honor, he at at a front table. realized that he could ignore pain, command in- IIe WitS then a man of SG, and during one partic- tense concentration, shifting focus at will, even ularly long session was thought to be asleep. He sleeping at will.In the middle of a tense confer- sat, immobile, eyes shut, unperturbed by events in ence, as one White House consultant remembers, the room, but when a breeze scuttled, some papers he called a break at a point of impasse and while down the table, it was Suzuki's hand that flashed others smoked or paced around, he leaned his head out and secured them after they had passed the back and slept for a few minutes.Oddly enough, presumably alert participants at the head of the one of the more important contributions of sleep table.Suzuki had been in meditation, delicately research in the long run may be that it can make balanced between relaxed detachment and instant these extiaordinary mental disciplines available to alertness.This state is well known to electro- all men. Research findings from the ERG labora- eneephilographers by itscharacteristic alpha tory have already indicated that it is possible to rhythm. teach ordinary people control over a level of con- Control of the Alpha Rhythm sciousness not usually experienced consciously. Dr. Joe Kamiya, at Langley Porter Institute in They have pointed to some of the unexplored San Francisco, has used the electroencephalo- phases of conscious states and the possibilities of graph as a teaching instrument demonstrating utilizing them. that control of the alpha state can be learned with The ramifications are endless.If people could surprising rapidity.Dr. Kamiya, in previous do something as simple as recognizing and describ- studies of sleep and dreaming, was struck with the ing the symptoms of illness, medical diagnosti- difficulty professed by volunteers in communicat- cians would be relieved of a time-consuming proce- ing their dreams and other subjective experiences. durethat of eliciting and then penetrating a con- However honest a person may be, most people are fusing verbal cloud.The ability to fall asleep notoriously inept at describing subjective events. promptly, at will, has obvious merit.Moreover, For this reason, many studies of perception, pain, recognition of the many tides of consciousness that and sleep have sidestepped introspective accounts. continue in sleep and waking might allow people Indeed, modern psychology has shunned introspec- to seize their best moments, performing at the tion.As a result we know little about the man- crest of their abilities.Must of us rise and fall ner in which civilized people acquire self-control, on inner tides largely unaware and unable to recog- how they exercise mental discipline and begin to nize them, proceeding through life with only the recognize and communicate their feeliags. barest acquaintanceship with our selves. Vega An infant can do nothing more than cry when literally means union.The body and mind are inseparable, and what we call mental discipline something hurts.The child, after some ,oaring from his parents, may point to his stomach. He might permit a new approach in the treatment of learns to say that his stomach hurts, and even- medical, or psychosomatic disorders, and nun). forms of mental disorder. tually he may discriminate between a stabbing pain From extraordinary and an ache. He will be almost mature before lie individuals we already know that voluntary control over pain, emotion, sleep, arousal, respiration, can describe his emotions even crudely.His dis- heart-rate, and many other functions must be crimination between inmost levels of consciousness possible. will probably remain aboriginal.The rich quali Perhaps the biggest disadvantage to the curric- tative variation bet ween dap sleep and high olum of self-control in eastern religions is that arousal does not even haveavocabulary. For it takes a long time, and the education does not example, most people experience the alpha state begin in childhood.The posture of Zen medita many times each day, but they would not know tion and shallow rhythmic breathing are difficult to how to identify it.

027-45---5 63 57 The characteristic alpha rhythm of about 9-12 rhythm when a single tone sounded and eliminat- e.p.s. appears when a person relaxes with eyes ing it when two tones sounded. None of the vol- closed.Thisisn'tdrowsiness.Therhythm unteers knew the name of the state they were try- vanishes on the threshold of sleep and also when ing to manipulate.They knew that a "yes" was a person becomes tense, emotionally upset, or associated with one sensation and a "no" with an- gripped by a problem. A Japanese EEG study of other. When the tone sounded once, the volun- Zen Buddhist monks has reportedly shown that tile teer conjured up the "yes" state. As they watched meditation state is a sustained period of alpha the EEG record hi the control room, the exileri- rhythm.Sustaining this rhythm is no mean trick, !fluters were amazed to see an alpha rhythm ap- for any call to attention, sudden thought, or out- pear after a single tone and vanish after the side distraction disrupts it. A study of the alpha double tone. state was ft logical first step in exploring the process The next variation of the experiment required of introspection because it occurs during. Ivakeful- a technical innovation. An electrical filter, cali- ness and is easily identified on the F.F.G. brated to pass only the subject's dominant alpha Six years ago Dr. Kiamiya and Hs associates rhythm, would sound a tone. Now the tone was wondered whether a native volunteer could be automatically controlled by the subject's alpha taught to identify the occurrence of his alpha rhythm; in a sense, his very thought controlled rhythm. They placed electrodes on a volunteer's the tone.The tone started whenever alpha ap- head, bade him lie down in an experimental bed peared and stayed on until the tiipha vanished. room and told him that a bell \vould occasionally Subjects were told to keep that tone off.They ring, sometimes when alpha waves appeared, \vere to suppress alpha.These volunteers were sometimes during other EEG patterns.lie was new to the study. They had never learned to iden- asked to guess whether or not the bell had rung tify alpha, nevertheless they were able to keep the during alpha and \vas told whether he was right tone from sounding most of the time. How had or wrong.By the fourth session the, volunteer they learned to control a subtle, mental state for was always correct in his guess and discriminated which they had no name? correctly 400 times in a row. Six other volunteers When they were asked, the volunteers said that achieved 'r0-100 percent accuracy on 50!;00 trials. the alpha state was serene, pleasant, and devoid Surely it looked as if they had learned to use some of visual imagery.Some volunteers said they internal cues to identify an inner experience they "saw" things in order to suppress alpha. and these. had never known before. But there was a remote visions were often floating, spots, faces, headlines. chance that the bell sounded different during Then the tone went off.It took some effort to keep alpha than nonalpha, and the procedure was the tone silent. they said, for when they main- varied to obviate this possibility. taed alpha on command they found they could Now the volunteers were instructed to say "yes" forget about outside stimulation -- including the when theyA they were in alpha and "no" when tone.Not all of the volunteers were equally adept, they weren't.This, too, they did with great "c- but the first eight subjects became skilled at turn- curacy.A number of physiological measures ing alpha on and off. When it was on. they said, were takenheart rate, respiration, eye move- they were re/axed yet vigilantlike, Dr. Suzuki? ments, and muscle tension to see whether one of The pleasant alpha suspension was giddily ban- these changed during alpha, providing thecue. ished \\ien ,hey exerted mental effort, evoked Although previous sttulies never indicated a rela- images, or tried to solve a problem. When asked tionship between alpha. and heart or respiration to maintain alpha and add memorized figures. the changes, this precautionary check gave evidence subject either maintained alpha and dill incorrect that ruled out palpitation of the heart, a change arit hmetie, (.4 he did correct arithemtie and lost in muscle tension, respiration, and eye movements alplm.Some people in other studies have man- RS CUM aged to solve simple problems and maintain alpha, The initial volunteer, the experimenters had no- and it has been speculated that it depends. upon the ticed, had inadvertently learned to control his amount of visualization employed. alpha rhythm once he learned to identify il.Vol - Zen teaching is based upon the ;t wakening of unteers in a subsequent study \rem told to induce inner perception to the core of one's being by an alpha or suppress it or c(mirmild, giving an alplu, itn listeningthat is destroyed by logic or effort

50 (3 4 of intellect.One student of Zen has described the trick of a famous prisoner in an American the sustained meditation as a portal to a poetic prison who used to astound the doctors by lying illumination, an appreciation of all physical self downdeadthen returning to life.This appar- and nature resembling the paradise of a child ent inhibition of sympathetic-autonomic activity a.ad incompatible with objective thinking. A stu- resembles the occurrences in the process of falling dent of Zen may learn to sustain meditation, after asleep and is an integral part of yogi meditation. many years, and to achieve the state known as At one time investigators reported that an accom- enlightenmentperhaps what might be described plished yogi could suspend his heart beat for 18 ns a union widi the unconscious.Dr. Kamiya's seconds.The observations were made by taking laboratory is attempting to see how long the alpha the pulse and listening, but electrocardiograms state can be held by volunteers with a few hours have shown that the heart doesn't stop.Instead, of practice,This study may explain one of the the volume of each beat is so diminished that only perplexing and repeated facts of historythat a most sensitive instrument will detect it.How monks and moguls have been said to meditate con- was this imperceptible volume attained?Surely tinuously for many hours a day rind to do with reduced heart beat is not accomplished as directly little sleep.Participants in a Zen retreat some- as moving an arm, although one step may be under times meditate for as long as 17 hours at a stretch direct voluntary control.By expanding the lungs and have been known to go without sleep for 5 days one can put pressure on the heart and reduce its or more. Recently, one participant in a retreat, a volume.The yogi feat takes skill and practice, Chicago housewife, is reported to have meditated but it resembles something that anyone con try fur 5 days without sleep. According to Dr. Albert for himself.One can produce, an increased heart J. Stunkard of the University of Pennsylvania, rate very simply by thinking alarming thoughts she showed no signs of fatigue.When introduced or conjuring up fearsome memories.Current into a conventional social situation she acted with findings by Dr. Kamiya also suggest that blood her accustomed propriety and responsiveness and pressure can be conditioned downward. suffered no distortions of vision, time, or other ef- The Putonomic nervous system, the involuntary fects usually associated with prolonged sleep loss. system that controls heart rate, perspiration, and Voluntary Control and Psychosomatic Medicine many vital functions, is now believed to play an active role in many psychosomatic diseases: heart Further FEG and polygraph studies may reveal ailments, ulcers, colitis, headaches, and skin dis- whether the alpha state does indeed perform some eases. people can learn to control their mental of the functions of sleep and what its special phys- If and emotional forces, they will also be controlling iological properties may be By using the EEG many of their physiological functions.Such a in a feedback system for instruction, Dr. Karniya development might put us on the road toward has been able to train people to identify, control, and sustain a state in a manner that apparently teaching patients to diminish their own symptoms and aiso to prevent psychosomatic disease, provid- takes years to achieve by Zen training. The same ing a very hteresting technique, moreover, to the

procedure will be used in attempts to instruct. psychotherapist.Research into the way we de- people in the control of other EEG patterns that velop cur introspective faculties, by offering us correlate with mental states. If, indeed, the EEG tools for further education, could have a profound picture corresponds with mental events this re- cattle well beyond practical possibilities for medi- search adventure is opening up the possibility of Such an education could internaleducation, avenues of instruction cine and psychiatry. in surely, to use the succinct clicht% enrich the lives mental control.People may, indeed, learn to dis- of people now 'compressed from every side by an criminate between the stages of sleep (Ant rohus, overpopuloir,overregulated, and increasingly 1965) and learn how to awaken during a particular technical society.The Utopian goal of inward phase, as some people do awaken at a regular time cultivation is mare distant, however, than some of without aid from alarm clocks. How does one "conquer" pain, "subdue" anger, reduce one's the more limited forms of control Ivo may be able breathing, stop ones heart I to acquire, We are now acquiring the tools to explore some Sleep Learning of the "superhuman" feats of the past.Simu- Sleep learning has been a particularly intrigu- lated death, for instance, and heart stoppage were ing possibility.Ifwe could learn French or elec-

rd 59 trical engineering during sleep, practical advan- training or psychotherapy.They suggested an tages are manifold.Could we take courses during exploration of the many waking states of con- sleep Could our lives be enriched by other kinds sciousnessthat are far beneath an optimum of useful training during sleep?Could our sleep- alertness. ing lives provide a part of our total education, a The Simon and Emmons papers performed a part of character formation, or even therapy? cleansing within the murky realm of sleep learn- During the last 20 years there has been a welter of ing. They did not, however, debunk the issue.If conflicting evidence, and these questions are by no factual learning of repeated words did not seem to means settled. Recent studies in Russia (Kulikov, occur in sleep, this did not mean that records play- 1964) and the United States (Evans et al., 19G5; iog throughout the night failed to penetrate the Cobb et al., 1964) suggest that it is possible for brain or that they might not have some effect dur- hypnotic subjects to understand relatively compli- ing the alpha state before sleep. cated things during sleep.Ir.deed, it has been said Subsequent behavioral p.nd neurophysiological that the Russians have succeeded in teaching some researches have amplified the case against a English during sleep, bat moz,, American scientists straightforward sleep teachingpresented as remain skeptical. progression of facts.The different sleep phases Studies of sleep behavior and neurophysiology have different properties, first of al/.As Webb have begun to map out some of the limits and pos- and others have shown, slow-wave sleep occupies sibilities of sleep learning and to illumine how the a goodly proportion of the initial part of the night. sleeping brain reacts and what it is capable of Slow-wave sleep would appear to be the least doing. Many people, of course, assume that sleep amenable for conventional teaching. In a number teaching is a reliable if slightly miraculous com- of experiments demonstrating that people can mercial technique offering success in acquiring make responses such as pressing a button during skills without effort.The great commercial en- sleep, the responses more rarely occurred during deavor began around 1947 when a successful dis- slow-wave sleep of stages 3 and 4.Quite a number tributor of foreign language records began selling of investigators have charted the brain's EEG the records with a loudspeaker designed to be response to a stimulus during sleep, and the placed under the pillow and a phonograph that studies of evoked potentials may help to explain turned on and off automatically.Advertisements the apparent impermeability of this phase of sleep. said that this equipment would enable people to In recent studies, Rosner and his associates at learn a language during sleep.By 1958 the busi- the West Haven, Conn., Veterans Administration ness had so expanded that there were records to Hospital compared the waking and sleeping brain improve salesmanship, to break habits, to enforce responses of people who were repeatedly given a diets, to enable a person to become financially suc- mild electric shock, causing a slight tingle at the c,e,ssfula more than $10 million business. median nerve of the wrist. Analyses of the EEG During the mid-1950's Dr. Charles W. Simon responses front many people and many nights and William Emmons at the Rand Corp. took a corroborated the many data that. REM sle;p bears close look nt the sleep-learning literatnre which a close resemblance to waking but that slow-wave then included a spate of scientific studies, onof sleep is quite different.Using sounds ns stimuli them weakly supporting the claim that instruc- in a study at Walter Reed, Williams found that tionin sleep improved waking performance. people gave EEG responses that changed in shape Simon and Emmons ran their own EEG study and in the various stages of sleep lunch like the re- decided that if they saw alpha rhythm in the rec- sponses to wrist shock (Williams et al., 1062, 1963). ord they would not assume the subject was asleep. Using quite another method, 1)r. W. R. Arley and Even with volunteers of high intelligence, there his laboratory nt UCLA have detected shifts in was no evidence that material "stunk" if presented impedance, the elect rical resistance of neural tis- (luring slow-wave sleep, and signs of learning sue at deep brain sites during sleep and waking. diminished as fl ?ph a, diminished. They concluded Drs.t.t yid Foulkes in Chicago and Joe Kamiya that there was no good case for factual learning San Francis, o have found that people report dif- during se. lie other form of train- ferent, kinds of mentatien iu slow -l-ave sleep than ing might be possible, perhaps the use of drowsy in REM sleep, generally remembering fire less. states to mo lify attitudes and supplement waking Now, the find rigs of Dr. Rosner and his associates

60 66 suggest why mentation during slow-.,vave sleep cause the tone had been coupled to the onset of the may be vastly different from that of waking or REM period the investigators wondered whether the REM phase of intense dreaming. subjects would begin to associate rapid eye move- Projecting in all directions from the thalamus ments with the tone without awakening. Many are small nerve fibers that finally refer sensory in- people felt that. motivation was important, and formation to the entire cortex, a diffuse projection ICamiya's subjects began to act as if they were system that is thought to be essential to conscious learning the relationship of tone and REMs-- awareness.Brain wave patterns, inferredto especially when 'he money payments increased. emanate from this region, appear toward the end After about 4 hours they were pressing the thumb of the EEG response to a stimulus. They do not switch just a little before the eye movements disappear in sleep, but, arrive later and progres- b-igan.This suggested that they had associated sively larger as sleep moves from stage 1 to stage the tone with the eye movements and had learned 4.It would seem that it takes longer for the internal sensations perhaps "warning" them that integrative, process to begin in this deep sleep, the eye movement period was about to begin. They showing what might be called a slower reaction were able, therefore, to tell the outside world that time, and longer for the process to occur.This they were dreaming or were about to dream. suggests a kind of slow motion in mental activity. A subject in a New York laboratory also learned Since speed of function plays a ':ole in the quality to discriminate between the REM state and other of thought, this evidence suggests that REM men- sleep (Antrobus et al., 1964). How does a sleep- tation would more nearly resemble that of waking. ing person tell the difference between one phase of During slow-wave sleep, moreover, the latter part sleep and arother?Does his inner experience in of the EEG response showed a shape that was the some way reflect changes that correspond with the reverse of the waking equivalent. A negative wave maegid changes observed on the EEG record ? occurred where a positive existed in waking. The Does he detect unusual body movement, respira- meaning of all this is not known in detail, but, it tion, eyo motions, vivid dreams?In pursuing this certainly adds to the evidence that says the brain's problem, Dr. Antrobus has not asked subjects to function is far different in slow-wave sleep than press rt. switch during a particular stage of sleep, waking. One might not expect. success in teaching but has asked for verbalidentification upon by methods that a:7e timed for a waking brain. awakenings. Can a person learn to identify dif- Roughly one-fifth of the night and a goodly por- ferent stages of sleep as he can learn to identify tion of the later part of the night is spent in a phase alpha rhythm? A study of one woman strongly of sleep that, by all the accumulated data, seems suggests that a person can learn to discriminate closest to waking: stage 1 REM. The shape of the about his inner sleeping experience (Antrobus, EEG response to stimulation is closest to the wak- 1965). The nurse in this study was awakened ing response in this period.This is the time of during REM sleep and stage 2.Although she vivid dreaming and a great variety of behaviors, knew them only as "A" or "B," she was asked to perhaps a time when specially timed teaching pro- guess in which phase she had been prior to awaken- cedures might prove effective.Obtainingre- ing and was always told whether or not she was spons:s from people in this stage of sleep is not correct.This training procedure lasted some 16 like asking a waking person to do something, however, and the particular properties of this sleep nights, and by the last, 4 nights the subject was stage can be glimpsed in some of the recent re- almost, 100 percent correct.Asked how she dis- search. criminated, she said she felt that there was something in the quality of the sleep, the quality of the Discriminations During Sleep dreaming, and the depth of sleep. At a time wile.), sleep learning looked like a dead Now the experimenter wanted to find out issue, two laboratories, separated by a continent, were quietly at work reopening the possibility. whether rapid eye movements proN ided a cne. On Kamiya and his associates at Langley Porter in several nights the subject was awakened during San Francisco were offering their volunteers money RENE periods only dining intervals when the eyes as a reward for performing during sleep.The were not moving, and also during stage 2 sleep. performance was not complicated. When a tone Once again, tl.snbject was nearly perfect. in he.. sounded, they were to press a thumb switch. 13e- discrimination and so it did not appear that rapid 61 eye movements themselves dictated her correct dis- nights. Now if the subject failed to close the mi- crimination of the REM stage. croswitch within 4 seconds of the tone, a fire alarm A further step, requiring the discrimination of began ringing, lights flashed, and his leg was still another phase of sleep has nct 1.,een conclu- shocked. Two of the subjects had been asked to sive.However, it does seem that the subjective discriminate between. an irrelevant and a critical quality of REM sleep and stage 2 permit a person tone.If they ignored the irrelevant tone nothing to distinguish between them.Individuals vary in happened, but failure to close th., switch after the their sensitivity tc internal experience, and most critical tone brought on the noise, flashing lights, people are inarticulate about, subjective ovents, so and shock. that it may take considerable et:ploration of this The motivating power of punishment was kind before there is n, verbal map even crudely de- clearly important. On the nights of grace with no scribing the "feeling" of the EEG stages of sleep. punishment for failure, the subjects hardly re- It is perhaps ironic that the experimenters and sponded, almost, not at all during REM sleep.On their cooperative subjects now haltiug,ly trying the nights vrhen failure meant punishment, how- to describe how they distim:oish between the EEG ever, they were responding to the critical tone stages of sleep are mapping a territory less known during all phases of sleep.The biggest ina[,rove- than the space traversed by the astronauts, un- molt could be seen in the REM period, and one charted seas of consciousness through which we all subject responded 85 percent of filo time when the pass unknowingly every night of our lives. critical tone wrs played during REM sleep t Wil- Performance During Sleep liams et al.,1063, 1064). has been clear in diverse studies of sleep be- Memory havior that people differ considerably in their These studies suggested that some kind of learn- reactions and their sensitivities.In addition, the ing might occur during sleep, that people indeed techniques of study hive varied considerably. In might be taught to discriminate between the phases one study of sleep discrimination the volunteers of sleep. They emphasized the importance of mo- -were motivated to perform in sleep by punishment tivation in getting anybody to do anything (luring for failure to respond. At the beginning of each sleep. A fu: i her aspect of sleep performance was REM periqd a /ight went on, as a cue :o the sleep emphasized by a study at UCLA. ing person that he was about to enter a REM pe- Drs, Mary and Arrold Mandell and Allen riod.If he did not --espond 'within a minute, a Jacobson used encouragement and careful instruc- buzzer sounded. When he pressed a switcit tion before sleep to motivate their subjects.Tits times, the light went off.There are a number of volunteers were told that they would hear numbers variations of this experiment, and in one series during their sleep.The task was to listen to the sutaje. is serei idly F. hocked if they failed to press spoken numbers and remember them but not to tho switch. Some subjects apparently needed lit- wake up until the experimenter invitcd waking. tle coax117,, and their performance, would improve The re:.orded numbers were played am : .titer JO from night to night without punishment, while seconds the volunteer was await:ate&If thonum- sonic ixople apparently got used to lights, buzz- bers were played during. slow-wave slap the vol- ers, shos.ks, and showed little inclination to per- unteers claimed they never leard them.How- form (Hammack, 1:42-61).Subjects in another ever, they were able to recite. the numbers played laborrory were receiving even stronger induce- during., REM sleep and repored that the inn hers ments to perform in the form of what might seem sometimes entered a dream (Mandell et al., 1J05). even plum irritating punishment for failure. Ten seconds, however, isitvery short time. In !he studies of Dr. Harold L, Williams and Further experiments are exploring the limits of his associates at Walter Reed, the volunteers slept memory during sleep. with a mieroswitch taped iu their right hands, and One of tliese st tidies has simply involved awaken- they were told to close it whenever a tone sounding the subject during sleep, presenting a word, ed.'They were given three nights of grace. For and Varying the amount of timethe person remains these first nights there were 110 dire consequences awake before falling back asleep.In the morning if they failed to close the switch when the tone the volunteers have been given tests of recall and sounded, and the tone was automatically turned recognition for the words they had seen and pro- off.However, life was different on the next thi ea nounced (luring the night.Retention, it would 62 E8 seem, depends upon how soon the person reeeiiing learning acquired during ;wakefulness, as in the the word goes back to sleep.If permitted to fall manner of people sleepirg through traffic sounds asleep almost directly, he appears to forget-3ug- but alerting to the opening of a door. gest ing that sleep, itself, can prevent the forming The investigators subsequently pursued the pos- of a memory (Portnotl et al., 19(5). sibility of sleep learning.Implanted cats, fast The shortness of memory for sleep events lay asleep, were shocked lightly when a certain tone account for one's ability to get up in the morn'ng was sounded. To avoid shock they merely had to and feel that the night was spent in an oblivion as alert themselves, and an EEG arousal pattern deep as death.The last few years of research 1 as permitted them to escape punishment. The, train- certainly shown that, far from being dead asleep, ing procedure was particularly delicate, as might the sleeping person is mentally active, capable ,)f be imagined. Only a -few shocks could be deliv- behaviors of many varietiestalking, walkin;, ered during any one session or the cat might be- dreaming, thinking, and be is impressively se 1- come too upset to sleep.However, it was soon sitive to significant events.This discriminatio clear that the cats did learn to associate the tone which as Ian °maid demonstrated, permits ape - and the shock, and the tone elicited the EEG pic- son to sleep through a stream of names but awake a ture of arousal.Strictly speaking, this may not to the sound of his own name, is a most impressive e have been sleep learning, because the training daily occurrence, yet one we take quite for granted. shocks had awakened tl-tem. The association of the It is expressed as "the baby's cry phenomenon" 1 y tone with the subsequent shocks probably occurred many investigators. A mother may sleep through after the shocks arrived and therefore in a wake- ti violent thunderstorm yet awaken if her bat y ful animal. The shock was then associated with coughs or cries (Oswald, 1960, 1961, 1962). the memory of the tone heard in sleep (Segundo, Experiments in Discrimination 1061; Buendia et al., 1663). Peop:a don't stop to marvel at the fact that t4!), The issue of memory span during sleep vt-asun- can sleep through fam'har noises yet waken if tie derscored by these studies. During sleep, the trace baby cries or a burglarlike footfall occurs in t is following th3 tone a brain wave pattern whose house. Dr. Jose P. Segundo and his associates at duration may indicate n-temory span for the sig- UCLA. have undertaken an experimental analy.ls nalis far smaller than during waking. Dr. Se- of this important discrimination. Their subjects gundo and his associitesvaried the interval were cats implanted with electrodes. While between tone and shock, and found that if it were awake, they were tt-aitted to diFeriminate between too long the animal never seemed to learn the rela- several tones that were close together in pitch so tion. A tone, followed by shock within 16 seconds, that one of the tones became associated with a for instance, was apparently connected by the shock to the paw.First, however, they heard all sleeping animal, and if-, learned to alert to the tone. tones over and over again until they simply did not However, when the 'ilterik followed the tore after react when they heard any of them. Then the e rit- 32 seconds, the sleeping animal apparently never ical tene vt as paired trith shock.I lowever, if the connected the two events and never learned to cut responded to the tone by nwaowing or tlexinits avoid shock (Izquierdo et nl.). paw, it managed to avoid the shodc. The w tole Material etesigrild for lamming in sleep appar- gamut of other tones were played, ineanw ently requires special pacing.It would seem that without shock.Now the animal was tested relationships can be imparter: by presenting the during sleep. related itemswhether they arc words or some- During all phases of sleep, the cats discrimi- thing elseclose together in time. nated between the critical tone and the irrele-ant Ina human study somewhat analogous to the ones. This was apparent on the EEG and in be- cat study, subjects discriminated between a signifi- havior. Whenever the critical tone sounded, the cant (shock-paired)tone and a neutral tone EEG patterns shifted toward the characteristic by showing a particular brain wave formation fast rhythms of ayousal.This happened before whenever the meaningful tone was played during the eats even movettHowever, when the h rel- deep sleep (Belt and ihirratt,1065). These subjeds evant tones sounded, there was Ito such arousal, who had been given chloral hydrate to induce sleep or at least it was far less ircquent. These cats tad showed no signs of shifting into a lighter stage of not learned durinj, sleep, but applied during sl sleep.Tests given to the subjects later, (hiring 6 9 63 waking, showed that the significance that had been This study was undertaken in order te find out conditioned during sleep carried over into the wak- whether responsiveness te suggestion during sleep ing state. The importance of this recent work is would permit hypnosis in a person of lo v suggesti- precisely that sleep-conditioning did not arouse the. bility. Eight young men participated in the study, subject and that it did carry over into waking. four of them demonstrably of high suggestibility, This study underscore ss one of the most mysterious four of them unresponsive. The procedure was aspects of recent studies of sleep learning and simple. The volunteer wore EEG electrodes and memory. went to sleep in the laboratory bedroom naturally, Many investigators have emphasized the indi- without hypnotic suggestion. During stage 1 sleep vidual differences they have observed and the by he was instructed to move his pillow whenever he no means uniform success in sleep-conditioning. heard the word "pillow," and during the deeper Some people awaken. Others do not respond. stages of sleep he heard an instruction to Ecratch When asked to recall dreams or words heard dur- his nose whenever lie beard the word "itch." The ing sleep, people have displayed a readiness to for- four deeply hypnotizable subjects responded very get rather than remember. In general, these re- differently from the less suggestible subjects who sults dampened the hope of accomplishing very either gave no response or showed signs of waking. much by sleep training, and surely the unsophisf The deeply hypnotizable subjects, on the contrary, cated attempts and commercial programs of the followed instruction. whenever it was administered past had not been encouraging. There is, however, in stage 1 sleep.Although they would scratch a singular group of people who seem to read dif- noses and move pillows at the mention of the cue ferently to sleep instruction and display faculties word, they did not recall any of this when of inemury for sleep learning. Nobody has deter- awakened in the morning. mined what properties of mind distinguished these The results have been replicated using a larger people, only that they are capable of being sample of 20 subjects who had not previously been hypnotized. screened for susceptibility to hypnosis.In the course of a free association test the nest day, they Steep Learning In Hypnotic SuLecis did react to cue words that were slipped in. A. recent Russian study of sleep instruction was More striking than that sign of carryover, how- performed on schoolchildren who had shown signs ever, was their performance on the subsequent of suggestibility.After the children were asleep night. Presented with cue words on a second for an hour or two, a tape recorder was trened on night, without any repetition of the instructions, at subthreshold levels. The child was told to con- they responded again in sleep. When subsequently tinue sleeping deeply and to listen and remember tested for susceptibility to hypnosis, a significant the test. The recorded text was either a Tolsto; but low correlation was obtained between suscep- story, or, if the child had shown some interest in tibility to hypnosis and the rate of responding to Pavlovian psychology, the text contained material the sleep suggestion (Cobb et 1961 ; Cobb et el., on higher nervous activity. When the text had 1965; Evans et al., 1065). been played, the subject was told to remember it Why does the deeply suggestible person follow forever and to sleep on.When tested on this instructions in sleep?What mysterious mental material during waking, a good many of the sub- attributes allow him not only to receive instruction jects could repeat the test without knowing how during sleep but to respond during waking and they had learned the material and performed as subsequent sleep?Studies of hypnotic subjects well as children who had been given the material may help to reveal overlooked possibilities in sleep during waking (Kulikov, 1904). There are a good learning.Efforts to find out whnt suggestibility many questions to be asked about the way in which means, and something about the hypnotic subject's this study was run. So many investigators have memory process, may also indicate whether elab- failed to inculcate even simple material during orate sleep learning cc's be accomplished in the sleep that this report may arouse some skepticism. ordinary person.During a recent pilot study at However, a team of investigators at the Institute the University of Pennsylvania, Drs. J. P. Brady of Pennsylvania Hospital have elicited an equally and B. S. Rosner found that tl-e hypnotic sugges- startling, and perhaps related, response in hyp- tion to dream produces a trance state with a wak- notizable adults. ing brain wave pattern accompanied by the rapid 70 64 eye movements that are characteristic of the vivid tion permits a person to adjust to a noisy neighbor- dreaming phase. Dreams reported by these hyp- hood or to sleep on a train or plane. The learning notic subjects sounded almost indistinguishable by which one does react to meaningful events, re- from nightly dreams, but unlike nighttime dreams maining unreactive to trivia, is essential for survi- that seem to evaporate from memory within sec- val, and for each individual it is somewhat differ- onds, these hypnotic dreamshaVe been remembered ent, since each life follows a singuiar course. 10 minutes and longer in great detail. What kind of brain mechanism would give us this It is interesting that only the hypnotizable sub- power of discrimination? jects showed rapid eye movements during their Segundo and his associates conjectured that the dreams. Other subjects were able to manufacture learned response is mediated by a neural "receptor dreams but had no conjugate eye movements. Was stage" that detects and identifies the ontsidz event. the hypnotized dreamer able to "switch on" part This discharges a "trigger mechanirm" according of tl.e brain activity involved in nightly dream- topitchorintensity.Finally,en".hector ing?Is the suggestible person capable of using mechanism" would orgauize the conditioned re- his brain, manipulating his state of consciousness, sponse.In tracking this mechanism to its very differently than the normal person ?Can he vokn- brain cells, the next study utilized microelectrodes tarily "turn on" brain states that we customarily implanted within single cells in the mesencephalic think of as involuntary ?EEG studies like this reticular formation in cats. This is the region that one may eventually begin to characterize the way participates in arousing the animal.Here, per- in whien the hypnotizable perxn functions by haps, one might see how the critical stimulls elucidating the brain activity in persons who seem finally elicited arousal in the animal. especially receptive to instruction and capable of This was an elaborate study, but briefly it in- retention.If it is possible to discover how the sg- volved stimulating the catperhaps by a touch gestible person uses his brain or, indeed, what on the shoulder, or by speaking to it, or turning brain mechanisms are called into play in acceding up the light in the ,:oomand catalogilg the dis- to a hypnotic suggestion, it may also be possible charge of the implanted nen: ons. Relative to the to teach such internal manipulations to "non- number of cells in this region very few were sur- suggestible" persons.Such a possibility might veyed, yet the survey showed cellular activity in open the door to unforeseen advances in psycho- unbelie ;able vari,.ty.Different cells responded to therapy.If elaborate sleep learning does indeed different sense signalssome handling several, occur and depends upon suggestibility, a greater others only reacting to one. Some cells discharged understanding of the nature of hypnosis may make regularly, like a metronome, regardless of stim- such sleep learning techniques available and useful ulation. Others responded in a restricted manner to humanity. This knowledge is likely to take a only when stimulation was applied in the form of long time in the gathering and probably at- a touch to the rleht upper lip, for instance, or the tract attention long before the evidence is obtained, hairy cf the c',eek.Some fired almost instantly, because it is one of the more glamorous aspects of 'tilers after r delay. The diversity of func- the problemthe yet unanswered questionof tion and mode r.1 fume.1 was enormous (Bell et learning complicated material during sleep. A al., MA). goed deal of our insight may come from neuro Wht n a reeve cell is repeatedly stimulated it physiological studies where already, in far less beg: tt.: to iLischarge less,However, cells attenu- sensational facets of sleep learning, we have ob- ated:iTerently.Some adapted to sound faster served one aspect that is exhibited by all normal than light but if allowed a rest would discharge people and animals. when restimulated.Some cells appeared partic- Hobituollon ularly sensitive to novelty, quickly attenuating in One kind of learning that does seem to occur their response after repeated stimulation. In this during sleepes it does during wakingis nega- array of receptor cells, novelty and habituation to tive learning. We rapidly learn not to get alarmed sern:ory stimulation wet: richly represented about meaningless events. With cats, if the crit- providing a means of conveying "significance." ical tone were repeated without shock, the tone This may be the neural background of a mist im- soon produced no arousal response, and the crea- portaM kind of learning, for an obvious survival ture slept through the night, This kind of extinc- value at aches to the ability to sleep through the

755 C 71 65 irrelevant yet awaken when external events are at all. They willingly, entered the recording cages. meaningful or threatening.By what code did Some of them furred.Once the: had adjusted the cells convey their messages to a trigger mech- to stimulation, a neutral tone was added.The anism in the next step toward a respons 3Neural tone was sounded with the stimulation.After messages resemble a code of pulses and spaces many pairings, the tone, by itself, was enough to rhythmically organizeda kind of Morse code make the cat sleepy and produce the EEG signs composed only of dots and pauses in tempo. In a of sleep. further study of a single giant nerve cell within a An analogous experiment has been performed by mollusk, Segundo and his associates are attempt- Drs. Clemente and Krauss on monkeys whose re- ing to learn something about this code (Moore et actions are closer to man's.This classical con- al., 1963; Segundo et al., 1963). ditioning; may explain why many of 1.1:7 fall asleep The learning involved in conttolling sleep onset at a habitual time, even though we ore not partic- has not yet been explicated in quite the same ularly tired. We have many habits surrounding manner. We all know that some people can fall sleep, rituals of washing, turning out lights, and sleep almost instantly at will, but how they do it associated cues including bedrooms, bedclothes, etc. remains a mystery. They may be particularly sen- This routine is conditioned iucliildhood and much sitive to body cues.Perhaps they pick the right of it persists throughout life.Perhaps radically moment to decide to fall asleep so that the dement different habits could be trainsd in infancy.Dr. of "will power" is combined with sensitive ad- Clemente has speculated that we might learn to justment to internal rhythms and some training. sleep less. One way to explore the possibility is to As fairly recent, studies have demonstrated, it is condition very young animals to sleep less than possible to condition sleep in a classical manner. they normally would. The first step in such studies Pavlov used inotphine injectionto condition isi. collection of data indicating how much a cer- sleep in dogs for xhoin the preliminaries of in- tain species does, indeed, sleep.Normative data jectim were cues to -fall asleep. His more famous on cats shows that they appear to be drowsy 15 dogs salivated at the sound of a bell, but the cats percent of the time, spend 40 percent of the time and monkeys or a current U( TA experiment fall in slow-wave sleep, and about a third of the time asleep. awake, the remainder in paradoxical sleep (Ster- Sleep man et al., 1964). Cond;tioning Stimulation of the forebrain synchronizing Drs. Carmine D. Clemente and M. B. Sterman area, coupled with a tone that permitted condition- at UCLA were probably the first io condition im- ing, srAggested that this brain region might be implanted cats to fall asleep at the sound of a tone plicated in habit formation and sleep regulation. A. survey of the litera- (Clements et al., 1963). After the normative study of cat sleep, each ani- ture led twin to expect that stimulation in an mal was given a surgical lesion, knocking out area in the basal forebrain might c.,use synchro- large numbers of nerve cells in the forebrain nous waves, the waves of sleep, to emanate from synchronizing area.After this surgery the cats Using an electrode in what is now the cortex. slept less and drowsed less.Further studs of this !mown as the forebrain synchronizing ar'a, they brain area may tell us a great deal about hypnotic would stimulate a cat, and it would drop into trance, coma, anesthesia., and the way in which sleep in 1-2 minutes. Through 4, window in each voluntary or conditioned controls evolve.The cage, the implanted cats could be watched as they basal forebrain contains a reinforcing center or wandered around.They would receive it stim- "pleasure center" that may well be involved in the ulation, and the EEG record would change from form iv, of habits. the low-voltage waking script to the rolling waves of sleep.The animal would Be down and dose Seep Habits its eyes.Altering the voltage and the length of Ifa bit, no dot.bt, playsme role in falling asleep stimulation had pronounced effect.At a voltage at night.Indeed, many peopleNi110take daytime just over 1.5 volts, a eat who had just assumed naps will perform part of their nightly ritual, un- a death grip on a live rat would, in the moment dressing and climbing into bed in order to sleep, of throttling, drop the rat and retreat drowsily to in accordance with the famous prescription of Sir a corner and sleep. Winston Churchill who felt that this wns the way The cats did not seem to mind this stimulation to obtain a refreshing nap. When and how are 66 .72 these sleep habits formed? Does infant training the daytime, during their normal sleep period, exert a lifelong influence? A good deal of infor- than at night when the rat would mIrrnally be mation has emerged from the studies of Dr. Wiise awake. Although little is known about the meta- 13. Webb and his associates at Gainesville, Fla. bolic clocks within the body that may produce this (Webb, 1957 G5; Agnew et al., 1964; 11.'1 lliams periodicity, they normally appear to be quite reg- et al., 1964). ular.Perhaps the maintenance of a regular bed In a look at Emily sleeping habits, a question- time enables people to take advantage of such naire survey has been conducted among 600 poojele periodieities within their bodies. whose ages range from 8 years to 80. This large Sleeping habits employ external cues such as group includes people who were reared according turning out lights, but they also involve internal to two very different infant feeding fads. Some cues, thoughts, and emotions.Advice on falling had been awakened on schedule for feeding during asleep usually contains the admonition: "Think infancy while others were fed on demand. Inso- of pleasant things." If that fails, bore yourself to far as the questie.inaire could indicate, there was sleep with a repetitive sequencecounting sheep. no dear relationship between these very different Counting sheep, or being rocked in a cradle are experiences in infancy and later sleep habits. repetitive stimuli that may be related to the direct Animal studies have been showing that the electrical stimulation that causes animals to sleep. younger the animal the more flexible is his sleep It is interesting to note that the stimulation, by response. Young rots can maintain themselves for which Dr. Clemente and his associates obtained long periods on a constantly rotating water wheel sleep in cats, was of low frequency.The fre- by sleeping in 10-15 second bursts, whereas older quency was similar to that of the synchronized rats much more quickly fatigue and fall off the waves of sleep. We may yet discover that a rhyth- wheel.Questionnaire responses have shown that inic event, timed like that of a person's sleep brain the amcunt of time r. person sleeps is related to his waves, is indeed soporific. age, the lifetime pattern forming a U-shaved Voluntary control over sleep may, in addition, curve in which infants and the elderly sleep the require more sensitivity to internal body cues than most.The number of times a person awakens most of us learn in our lives.If cycles of physio- during the night is also related to age and in- logical change and mental states indicate an opti- creases with age.In all age groups, however. mum time for falling asleep, we might learn to there seemed to be a very striking and consistent heed our fluctuations in attention, sense of heat or relationship between "good" sleep and what our chill, muscular coordination, and other cues. A grandmothers might have prescribed as "regular number of studies on the determinants of sleep sleep habits."People w'io maintained a regular may reveal whether we do, indeed, ignore such bedtime and regular time of awakening generally cues and whether there are optimum periods for reported that it was easy to gL to sleep, suffered falling asleep. fewer nighttime awakenings, and felt refreshed The Awat:enirg Process when they awakened in the morning. It is also conceivable that people may learn from There may be some relationship between this current sleep studies useful information about the finding and recent evidence from the aninie i lab- process of awakening and when awakening occurs oratory.Using rats as subjects, this laboratory most easily.Until recently there has been little has investigated many factors Ehat. might. alter the interest in the process of awakening.Studies in likelihood of falling asleep. For instance, it has the Gainesville, Fla., laboratory have indicated been found that sound might cause an animal to that people show great individu d differences even take a long time falling asleep whereas light had when their motivation, training, and tasks are no stieh effect.Rats are diurnal animals.Nor- constant.Measurements of handgrip., forin- mally, they sleep during the daytime, Although stance, suggest that muscular strength may bo low rats vary as individuals, some falling asleep with when a person first awakens, returning slowly to ease, others showing a tendency to have difficulty the normal waking level (Webb and Jeanneret; in frilling asleep, the most significant determinent Webb and Agnew). More recent work suggests of their sleep response appears to be the diurnal that an important factor in the cue of awakening periodicity. External means of encouraging them is not the length of time a person has been asleep to fall asleep rapidly are far more effective during .but the stage of si,ep from which he is called to

73 67 wakefulness.The difficulty in arousing people help to settle the problem. We lave, however, from sleep during the early part of the night may begun to recognize these problems, ; nd that is the reflect the fact that the deep slow -wave stage 4 sign of a giant stride into a region of human life, occurs most frequently in that initial period. of activity and consciousness, that never before Since people may be able to learn to discriminate seemed so rich. between REM sleep and stage 2, perhaps the dis- Although the conditioning of brain rave se- crimination can be further refined. A person quences and the exploration of introspective might then learn to awaken from a stage of light development may seem Olympian and distant sleep, an optimum point on the cycle, for it seems from practical application, such studies may ulti- very likely that awakening comes more easily mately offer powerful new techniques to the from some phases of sleep than others. medical doctor and to the psychotherapist and Summary psychiatrist through 'tstruction in physical and Voluntary control over sleep behavior and, in- mental control. We have discovered that people deed, some facets of waking consciousness, have can discriminate between one phase of sleep and come into systematic investiga tion only recently. another, can accept some information during sleep, Only a bare beginning has been mad. in the study and can communicate with the outside worid. of sleep behavior itself. Even in t'ripartial re- They can learn to control states of consciousness view, it must be clear that there are many diffi- that they couldn't previously identify and for culties inherent i.0 this area of study. Not least which they had no awareness. The EEG, used among them may be our difficulty in defining as a feedback system, may make it possible to sleep.Some people can resiyand to the outside instruct people in the verbally incommunicable. world without showing apparent EEO changes Most of these findings cannot bo applied at once, in their sleep, yet others show rhythms resembling but progress has been rapid, for the work cited those we identify with waking. Moreover, people here has been accomplished largely in the last ha,e been known to sleepwalk out of the EEGs 5 years.It is clear that the feats of a Iiamid of deep sleep, or to show sleeping brain waves Bey hold some considcalble interest for us still, while seemingly wide awake.The behavior of although in a new light.Self-sovereignty and lying still with eyes closed is not enough to tell full access to one's own richness of consciousness us that a person is asleep, and sleeplike brain waves is the supposed epitome of the cultivated man, 'nay be contra,ii6ed by apparently alert behavior. yet the discipline of body and mind that might The fact that there appear to be two extremely dif- mould such an ideal have long been neglected by ferent kinds of sleep and that behavior during the Judeo-Christian majority of the Western REM sleep often differs from the rest, does not World. 74

68 The Marquis d'Hervey attributes complete liberty of action and attention to the intelligence during deep, and he seems to think that sleep consists wrely in the blocking of the senses, in their being closed to the external world. So that on his view a sleeping man would hardly be different from a man who shut off his senses and allowed his thoughts to wander. Maury It 14 quite likely ... that a modificdtion of our attitude towards deems will at the same time affect our views upon the internal mechanism of mental disorders, and that we shall be working towards 2,, explanation of the, psychoses while we are endeavouring to throw some light on the mystery dreams. Freud You will see stout horses, even when their bodies are lying down yet in their sleep sweat and pant without easing, and strain their powers to the utmost as if for thc prize, or as if the barriers were thrown about open. And often during soft repose the dogs of hunters do yet 111 at once throw about with their legs and suddenly utter cries and repeatedly sniff the air with their nostrils.... Lncretius

Chapter VII. The Dream State of REM Once upon a time, before 1952, most people adults and saw that there were recurrent intervals thought that dreams were rate events, perhaps of body quiescence when tho eyes began making caused by bodily discomfort or aching conscience, rapid jerky movements beneath the closed lids. by trauma, sensory stimulation, or the insurgence At that time it was a curious and startling observa- of an unruly subconscious. The discovery that tion, and it took some doing on the part of a grad- all people dream every night camo as a sur- uate student to demonstrate that this periodic ac- prise to many although a large number of classical tivity did indeed occur in sleep. When AserLo studies had already heralded the finding.Like sky and Kleitman watched sleeping volunteers many developments in science, a long progression they saw that the rapid eye movements (RIMS) of researchers composed the prelude to the work of occurred periodically, at a time when there were this decade although the earlier work attracted sharp increases in respiration and heart rate and less public attention. the EEG showed a low-voltage, desynchronized The germinal studict., from which much of pattern ye.different from the rolling waves of modern sleep research ha? hureconed, began in- deep sleep (Aserinsky and Kleitman, 1953, 1355; nocuously enough at the University of Chicago Kleitman, 1060, 1963). where Dr. Nathaniel Kleitman devoted himself Bad, in the 1930's, shrewd observers indicated single-mindedly to the study of sleep. Dr. Eugene that this EEG pattern meant dreaming qualita- Aserinsky, then a graduate student working with tively different from dreaming in other stages of Kleitman, turned attention toward phenomena sleep but the time was not then ripo for a surge of that had been ..,potted before and never thoroughly corroborating research on this phase of p. studied.Aserinsky, studying the movements of When Aserinsky and Kleitman awakened volun- sleeping infants, was arrested by the fact that the teers during this REM and EEG pattern, subjects slow rolling movements of the eyes would stop almost always narrined a dream, while awakenings periodically, for intervals.Ile began to watch at other periods of sleep rarely evoked such reports.

S9 Dr. William C. Dement, then also a graduate were discovered.Tocley they are taken for student at Chicago, pursued the finding, affirming granted, bus at that time masses of dt to and many the coincidence of dreaming with the REM and confirmations were required to persuade the scien- low-voltage EEG pattern (Dement and Kleitman tists that they really had found what they thought 1957),Subsevently ho noted the same pattern they had found. Everybody dreamt every night, in the sleep of cats, a finding confirmed by Dr. and moreover, they dreamt in regular cycles, each Michel Jouvet of the Frontit of Medicine in for roughly the same amount of time (Dement, Lyon (Jouvet, 1960).At this point two major 1965). Subjectively it is easier to think of dream- paths of dream exploration had begun in the ani- ing as infrequent, because, in part, memory for mal laboratory of neurophysiology and in the dreams is so brief. Yet the assortment of students EEG laboratory where human volunteers came to and housewives who were paid to sleep in Abbot sleep out the night. Hall at the University of Chicago gave richly Nobody could have predicted how rapidly sleep detailed dream narratives when awakened during research would capture the scientific imagination. REM periods. As Dement and other investigators Where a few men with solitary persistence had con- repeatedly awakened volunteers it became dear centrated on the overlooked third of life, in 10 that young adults had a similar pritern of vivid years there followed a new generation of scientists, dream episodes.Abort 90 minutes after falling many of whom elected sleep as their province of asleep they would rise into a REM state, usually research. From the start the arresting differences for a short period, about 10 minutes, then sink between the REM intervals and the rest of sleep down into deep sleep for about an hour before suggested that REM was a unique physiological rising again for a longer dream period. Hundreds and psychological state.The physiology, itself, and hundreds of people have now been recorded, began to show a unique configuration first emerg- and the average young adult seems to dream about ing from the studies of Dr. Frederick Snyder and 20-25 percent of his sleeping time, in five or so his associates at NIH (Snyder, 1960). REM periods, at roughly hourly intervals.Indi- Since 1952 so much data has come pouring out viduals appear to have somewhat distinctive pat- of the laboratories that it cannot be recounted in terns, and some investigators can look at a person's a small space. A sampling may indicate what we EEG record of several nights' sleep and predict have learned about the amount of REM dreaming when he will start dreaming, and for how long. in humans and animals and what it may indicate The very discovery of an outside handle to a about the evolution of the mammal brain, the de- person's dreams set a blaze in the imaginations velopment of the normal infant brain, mental of psychologists and psychiatrists. Was this hygiene, and mental illness.Many of our clues EEG state akin to the hallucinating states of psy- about the physiology of dreaming have come :1 chotics or the DT's of alcoholics? Were certain bits and pieces, as have our data showing the na- psychotic symptoms merely displaced dreaming, ture of brain activity during dreaming, with im- If everyb'dy dreamed a certain amount each plientions that may aid our understanding of night, what hal, pened when a person couldn't mental illness.Aithough the bits and pieces do dream? not fit together as a neat whole., they have been REM Deprivation generally congruent, linkieg activity of body, During the mid-1950's, Dr. Dement, working mind, and behavior in a way that has advanced with Dr. Charles Fisher at Mount Sinai Hospital the study of human behavior another slap out of in New York, began the first of a series of dream the dark ages of phenomenology. There is no neat deprivation experiments.Volunteers, carefully way to isolate research in neurophysiology from observed and questioned, and under strict rules research on bodily changes during dreaming, or not to take alcohol or drugs or naps, were allowed personality factors, nor to isolate the chemistry to sleep their usual sleep in the laboratory except of dreaming, or behavioral data, and so the group- for REM periods. At the first sign of rapid eye ing used to describe studies of the dreaming state movement and EEG desynchronized pattern, the is somewhat arbitrary. subject was awakened, then permitted to go back The REM Cycle to sleep.For five successive nights the volunteers Back in the olden days of dream research, littlo were awakened in this manner. Although they more than a decade ago, two very remarkable facts, had gotten about 6 hours of sleep, some of them 70 7E; complained of psychological discomfort, began to need to dream appears to be uniform, or perhaps eat more than ustiel, and suffered anxiety.One one should say, the need for REM s'eep. subject quit the study after several days in an Today, with mounting- evidence :rom animal apparent panic.This did not happen to thecrni- studies, it appears that the need for REM sleep trol subjects whose equivalent awakenings took must be more than tpsychological need.The placein non-REM periods(Dement, 1060). dreaming of the REM stale is a physiological as The initial study, which has since been reexecuted well as a psychological process.Indeed, it has in many variations, created a great flare of excite- been thought that the psychological disruptions ment.It suggested that people needed to dream. observed in some volunteers after dream deriva- Not only did deprived subjects complain of some tion are actually the signals of a physical penalty psychological discomfort, but on each successive that may have to be pail if the REM cycle is pre- night they attempted to dream more often.After vented for too long a time.Nevertheless, it is in- their stint of dream deprivation, when they slept teresting that people have varied in their reactions undisturbed in the laboratory, they dreamed about in the several deprivation studies so far. The very 60 percent more than they had on baseline nights. fact that some people show effects and others do They appeared to be making up for lost dreams. not raises questions that are germane to a wide Initially, the psychological facet of the need to variety of human studies in psychology, and may dream captured the most attention.Deprive a be worth examining as an instance of the uncer- person of his dreams, the study suggested, and he taintiesfacing scientistswithinthe broader begins to suffer psychological abnormalities. This context. interpretationcoincidednicelywithFreud's Why have some subjects felt at.xious, empty, theory that dreaming formed the safety valve of hungry, unable to concentrate, a few of them even mankind, permitting an expression for the many extremely unsettled after a degree of REM loss drives and impulses that civilized man must that had 110 such effects upon subjects in other repress.Manysubsequentdream-deprivation studies?Possibly, in some of the initial and short studies have thrown this interpretation into ques- studies the experimenters clic', not sea in their tion.Dement, himself, and many others have screening of volunteers that they were in a state sometimes failed to notice any marked psycho- of fatigue. Subjects may have been more anxious logical changes even after more thorough and ex- to begin with than was apparent on testing. There tended deprivation.But the need to dreamas is another possibility, albeit unlikely. Sometimes expressed in ever increasing attempts to dream even the most cautious experimenter may inad- and in a huge and unambiguous orgy of compen- vertently reveal his expectations by ems so subtle satory REM time following deprivationhas that the subjects will live up to an expected role been seen in every deprivation experiment, human without even knowing they are doing so.This has or animal.Dr. Charles Sawyer and his associates been a pitfall in many studies of hypnosis, but it at UCLA deprived rabbits of REM sleep by leav- seems an unlikely explanation here, because ani- ing them in a chamber where a hissing noise was mals deprived of REM sleep have shown pro- continuously played. When the noise was turned nounced behavioral symptoms. off, the rabbits appeared to make up lost. REM Cats, deprived of their activated REM phase time with more frequent and longer REM periods. for long enough, show very bizarre behavior dis- Dr. Michel Jouvet and his associates in Lyon have orders.Cats have been deprived of REM sleep deprived cats of REM sleep for as long as 26 days. in several ways. They have been placed upon a Subsequently aPewed uninterrupted sleep, the stone or other object surrounded by water. This cats spent about 60 percent of their time in the permitted them slow-wave sleep, but they would REM state and fell directly into that state from topple into cold water whenever their neck and waking.This compensatory dreaming has been head muscles relaxed at the onset of REM sleep. observed in people, among them dexedrine addlets In some studies they have been awakened by an and alcoholics who have been withdrawn from attendant and set upon their feet the moment their dream-suppressing drugs.It has been seen among EEGs and muscle tonus signaled the onset of the totally sleep deprived and among some psy- REM periods.Jouvet has observed distinctions chotics after periods of reduced RE!t ti.ne.The between deprived and normal laboratorycats,

71 even after mode -ate deprivation.The deprived riod. After eight nights the first subject was try- animals were, in Jouvet's expression, tired, sad ing to dream so often and it was so hard to wrestle cats. Visitors to the Lyon laboratory were able to him awake that it became impossible t, deprive pick out cats who had been REM deprived a year him of REM sleep without totally depriving him earlier because they were so subdued and unaggres- of sleep.lie would start dreaming the moment sive. More recently, Dement and Jouvet have sub- he was allowed to close his eyes and fall asleep. jected cats to prolonged deprivation periods ofSO- The next volunteer was given dexedrine to sup- 70 days.These cats have exhibited a variety of press dreaming. He, too, began dreaming more disturbances. Some have become "hungry," eating and more often.Soon the investigators had to abnormally, restless and indiscriminately hyper- awaken him incessantly. By the 15th night he was sexual.They have acted as if their basic drives dreaming as soon as he closed his eyes, a behavior were enhanced by the deprivation. seen among narcoleptics, certain psychotics, or In studying human beings, the experimenters after drug withdrawal.By this time he had have always terminated the deprivation long be- changed from a taciturn, compunctious, moral per- fore there were such abnormal signs out of appre- .;on into a blue-streak talker, an unreliable subject, hension that REM loss 'night cause irreversible a man who wanted to sit. in a nightclub without damage.Dement and his associates have been ordering drinks until he was thrown out. On his studying cats trader partial deprivation and severe first night of recovery he dreamed 120 percent deprivation to see whether there is damage to the more than usual and reverted back to his normal nervous system. When a cat's nervous system is self.The th'rd subject showed a personality in any way "poisoned" there will be a discernible transformation after 14 nights of deprivation, and difference in its EEG after hearing a click. One the experiment was terminated after 16 nights. of the tests for REM loss damage has been a series On the next night he dreamed 160 percent more of recordings from the cochlear nucleus of cats. than his usual REAP quota, and he, too reverted to This is a first relay station kr the sound impulse hi- usual self (Dement, 1965). traveling upward in the brain. A first study has Another subject deprived of dreams for 16 shown that the EEG response changes consider- nights by Dement and Fisher had shown no psy- ably in the REM d.eprived cats, returning to nor- chotic symptoms, but he evinced obviously dis- ms.] after the animal has been allowed REM sleep. turbed behavior, memory disturbances, time sense Control animals, awakened on the same schedule distortions, preoccupations, and an inability to as the deprived cats, showed no change in EEG work. He sat around in a stupor most of the day, response (Dewson et al., 1965).Other signs of yet when he was heing jested or interviewed, he altered sensitivity within regions of the brain may managed to r .obilize his forces. This is probebly accompany REM loss, perhaps associated with an important issue in many psychological studies, biochemical changes. These may indeed be related for as everyone knows from experience, it is pos- to the behavioral changes noted. sible to be exhausted, distraught, and largely im- Notwithstanding the animal studies, there have mobilized, yet summon up all one's resources at a been several dream deprivation studies conducted critical moment and give a. good performance. with human volunteers, which have shown appar- All in all there have been few studies of pro- ently conflicting results.Subjected to 5 days of longed dream deprivation.This is nndersiand- REM deprivation, and not total deprivation at able because it is a monumental strain on the that, volunteers reporteirritability, emptiness, e:rclurance of investigators.Each subject must be anxiety and other symptoms (Dement- 1960). ,nonitored continuously, da j and night. The ex- Yet a person in a later study conducted by the same perimenter must keep a tense vigil throughout experimenters, endured 13 consecutive nights of several nights of baseline recording, then main- dream deprivation with few signs of changes. tain a split-second alertness throughout the eon- More recently, Dement and his associates went sent ivo deprivation nights, followed by the nights through a grueling vigil in order to deprive three of recovery sleep. subjects of all REM sleep for 16 days. This time Ona recent deprivatica study of two young men the subjects were awakened the moment muscle was prompted by the discrepancies in psycholog- tone disappeared under the chin, an event that ical reactions (Kates et al., 1064). The subjects usually precedes the other signals of a REM pc- were under constant observation, and were de- 72 78 prived of REM periods in two separate experi- res +arch program conducted by Dr. Barbara ments.For 6 nights, the rapid eye movements 13ia WTI and her associates at the Sepulveda V. A. formed the awakening signals, whereas for 10 Ho: pital. The behavioral traits of 10) cats weae consecutive Alights the loss of muscle tcnus was, cate ".orized by a Qasort technique, and subse- used as the alarm clock. In both studies neither quer i; studies showed that distinctive EEG charac- psychological testing nor direct observation re- teris ics occurred with each of the major "person - vealed any significant changes.Bath volunteers ality' groups. The purpose of this classification reportedvivid dreams and fragments when was a obtain some baseline of an animal's behav- awakened, suggesting that they obtained several ior b fore testing on him psychotropic drugs in seconds of dreaming even before loss of muscle doses :..ompa rable to those that would be given the tone signaled the investigators to awaken them. hurna ipati -nt. Two striking studies will illus- The investigators conjectured that this brief pe- trate he extent of the EEG-behavioral differences riod contained a great deal of compressed and per- obsealiK1 among these cats.Usually, when an ani- haps accelerated dreaming, and they concluded mal e plores a new cage, orienting himself so to that despite marked REM deprivation they were speak, he will show a theta rhythm from the hippo- not really dream depriving subjects. e.ampt aThe frequency of theta decreases as the There is still another possibility.Inaividuals cats b come adapted to the new cage.Cats who may vary considerably in the amount of REM had b en categorized as "average," when placed loss they can stand before they begin to show pal- in a E range recording cage spent the least time pable signs. Although researchers have been care- exploi ng before settling down to sleep, and ful to avoid accepting volunteers who are neurotic, shove. their theta rhythm at this time, but i soon overtired, or in an obviously precarious mental vanisl xi as they adapted. Cats who were cate- state, there is a great range of constitutional and gorize l as "anxious, or withdrawn" spent consid- personality differences in humankind. Members erable time exploring the new cage, and showed a of the U.S. astronaut team, who have demonstrat- great!eat of theta, at a very high frequency usu- ed a certain hale and rugged capacity to with- allyen in activated (REM) sleep.Cats de- stand all manner of stresses differ from other scribe. as "overly outgoing" also spent a long time members of the population who are nevertheless explo ing and adapting, showed a great deal of quite healthy. Peep le differ considerably in their theta. Jut of a lower frequency than the rhythm of response to a simple test ouch as placing a hand the of ier cats. in cold water for a brief time.Perhaps the dif- Us ally, during activated or dreaming sleep the ferent responses to Intervals of REM deprivation cat a ;ain shows the hippo-mmpal tneta rhythm. reflect another dimension on which human be- Cats scored as "average" showed theta sleep the ings vary, and tlAe point of psychological suscepti- first ime they were in the recording cage.Both bility may vary both among people and within the "out: and "withdrawn or anxious" animals same person during different stages of his life. took .s long as four or six sessions in the r< 2ording One might still expect that tilt re would be a limit cage aafore they showed theta during sleep.Min- beyond which an individual could not suffer REM imal i beta during orienting, and the appn ranee of loss without palpable signs. theti during sleep might indeed be said to be a if there is an element of individual differences slur of quick adaptation, theta perhaps represent- in tolerance to dream loss, and indeed a wide dis- ing SI fundamental behavioral signpost. tribution ofmental-constitutimaaltraits,one Di ferences between the "average" cats, and the might expect to .9C4 a similar diversity in animals, "mitt }ing" or "withdrawn" animals reasserted some evidence in animal studies of marked diver- them, ?Ives when the animals were given a small sity within the same species.There have been a anion Jt of alcohol. Within the first 20-30 minutes number of cases beari g on this point, and one after 'heir drink, all of the "outgoing" were drows- which is particularly relevant. ing or 'Bleep, although some of the animals showed Personality and EEG Differences to Cots and u wake EEG. Similarly, all of the "with- Although we tend to treat animals the same in draw' " cats were asleep within a half hour after the laboratory, everyone is aware that eats differ takini their drink, but these cats showed a slow from one another much as people do. A demon- and sl ?ephke EEG in the experimental situation. stration of tl Iso differences has been part of a long even b ?fore sleep.By contrast, tae "average" cats 79 73 were awake and alert for 2 hours after their drink, F. wo subjects showed a slight increase in the per- and although none slept. some showed a sleep EEG centage of REM sleep throughout these 10 base- while others showed an EEG of waking. Behav- line nights, while 2 other subjects gave every iorally, in any event, the "overage" cats reacted to evidence of a constant REM quota after their first alcohol very differently from the deviant animals. 2 nights in the laboratory.This suggests that it Esperiments with REM deprived cats suggest may be necessary to observe some laboratory vol- that there may be some difference among the ani- unteers for a very long time before concluding mals, but this has not been the focus of these stud- what percentage of their sleep time is spent in ies. These studies are yielding essential informa- the REM period (Dement et al,, 1965). Whether tion that cannot be obtained from hum,studies. these differences reflect reactions to the laboratory One such study may be important in understand- situatich, to events in the person's life, or to ing what happens when a rercon continuously suf- changes in schedule, diet, or physiology, they illus- fers a small reduction in REM dreaming, either trate some of the difficulties inherent in dream- because he has a sleep disturbance or mental ill- sleep research. ness, or because lie takes drugs or is alcoholic. For all the individual diversity in reaction to PartialDreamDeprivation dream loss, and for all the variance seen in ani- One .search study on human volunteers has mals, one factor remains unchanged. An indi- suggested that there may be differences in the way vidual spends a fairly constant portion of his sleep people compensate for partial dream loss, certainly in REM dreembst. When his REM quota is re- over short intervals (Sampson, 1965), duced, whether it occurs as a result of fever, of Dr. Harold Sampson of Mount Zion Hospital, anxiety, of alcohol, drugs, or awakening, he will San Francisco, has been Y.atching for any detect- dream more on subsequent nights. able p,-,ychclogical changes that might come from Of course, when en experimenter deprives an partial dream deprivation, but a deprivation not individual of REM sleep, or when a person de- occasioned by constant awakenings or by drugs. prives himself either through illness, by cutting Subjects in this study go for several consecutive down on sleep, or by drugshe is not just losing dreams. The brilliant episodes of inward experi- nights with only 21/2 hours of sleep.Here individuals differ greatly in the rapidity with which ence are summoned by the activity of the brain, and are accompanied by bodily processes.The they begin to dream and how Touch of their sleep is taken up in dreaming. For instance, one per- lost intervals are not only psychological, as rapid eye movements, themselves, might have suggested. son dreamed for a full hour on his second night of reduced sleep, but only 10 minutes the next The process in which our most memorable dreaming seems to occur is an integrated neural process, night, and showed almost no compensatory dream- related to the surging of our emotions, the behavior ing on recovery nights of full sleep. Another per- of our bodies. Within the experience of the dream son managed to dream for only 1 minute on the itself, the memories we summon, the euphoria or first deprivation night, for 15 minutes on the next, rage we feel must follow some laws by which the and about 90 minute; on the third night.These central ner.ous system and indeed our entire body signs may be reflecting constitutional differences and being operate (Fair, 1963). in reacting to dream loss. Another, perhaps related, incident of individual Muscle Tone variation was observed in an experiment that was, When the REM period is excerpted from even a roughly speaking, designed to see whether a per- single night of sleep, a huge variety of body aetivi son compensates for 5 nights of total REM depri- ties must go with it, for the unique properties of vation and for 20 nights of 95 percent REM the HEM dream period are not restricted to the deprivation with the same amount of recovery brain.The brains peculiar activity at this time REM time.After 20 nights of partial (25 pee- is correlated with effects throughout the muscles cent) REM loss, 1 subject showed an increase that and in the autonomic system. would have been compatible with 5 days of total The mos', dramatic demonstration of changes deprivation.However, something very interest- in muscle tone is the eataplectic fie of e narcoleptic ing had been noticed during the 10 col secutive who goes through no slow transitions but falls nights durTog which the experimenters were com- directly into a REM ct,te and collap3es like jelly. puting the object's normal quota of REM sleep. The relaxation of sleep involves a decrease of elec- '/4 80 trical activity in muscles throughout the body. of REM sleep have been found in all mammals These changes have been observed by many but investigated: in the lamb, ass, goat, even in birds. were recently mapped in a thorough way by a team Physiological Excitation of UCLA researchers (Jacobson etal., 10G4; During these periods of REM sleep animals and Det.,,.d, 1965). They found that the body mus- men seem to be swept by waves of physiological cles do not show marked changes from one stage of sleep to another.Clearly, they retain some activity, storms of neural excitement. The ripples of activity on the surface are more noticeable than potential, because people do move and turn.Dur- ing stage 4 some people even get up and walk eye movements, and could be seen by any careful in their sleep. observer.They did not attract attention and Many people have noticed that a study in the past, partly because people were not person turns and moves as he approaches a dream looking, and partly no doubt because bedclothes period, like a person settling in a theater seat. obscured body movement. Active sleep i3 quite before the curtain. Then he is relatively quiet. apparent in infants. By using surface electrodes on volunteers, the Out of a quiescent serenity an infant can be seen, suddenly frowning, sucking, UCLA. team watched the changing activity levels grimacing, his breathing uneven, his fists waving of 29 muscles during sleep.Occasionally there and uncurling, feet kicking. Anybody can see would be bursts, some of these corresponding with these signs.Although periods of "disturbed" twitches during REM periods, but in general then sleep, probably REM periods, had been observed the activity levelz were low. At the onset of REM in the 1920's by a clinician who speculated that sleep, however, .e head and neck muscles show a sharp decrease ..i tonus. they were associated with dreams and instances of This is such a reliable cardiac catastrophe, no careful sleep studies of phenomenon that the muscle under the chin has been used as a REM alarm clock. heart rate and respiration were made at that tine. By placing an electrode on the chin muscle, its There was no correlation between the EEG and sudden decrease in electrical activity can be used "disturbed sleep" (MacWilliams). The intuition to activate a switch, telling an experimenter in was nevertheless a sound one, for it is during the early morning hours, the time when people have another room when an animal or person has started dreaming. The same technique has been useful their longest dream periods, that inexplicable heart with small babies, permitting a count of their attacks sometimes occur. During early studies of REM time without burdening them with other the REM period in adults, Aserinsky and Kleit- man observed that the heart rate and respiration electrodes. rate seemed to increase in these intervals. Because certain head muscles lose tonus at the The net of REM sleep, it is perfectly apparent when- physiology of the dream state warranted a. much ever a rabbit starts to dream.This is the one closer examination, and it was Dr. Frederick Snyder and his associates at MAUI, who initiated lime when its ears flop.Ordinarily the creature the now extensive exploration, starting in the late -vill stretch out in a number of positions to sleep, ears held straight back, but during the REM st: to 1950's.As their research program has begun to they suddenly droop. indicate, the physiology of the REM state, has many ramifications for medicine, for the treat- The picture of an animal in this phase of sleep i3 familiar to any pet owner. The paws, tail, ment of cardiac patients, epileptics, and many pa- and whiskers occasionally twitch, the animal may tients whose symptoms appear to be exacerbated during those particular hours in which REM sleep Fa or suck or even emit barks or cries.Some- times hisextremities are slightly convulsed in prevails. nyoelonic jerks.Occasionally peril,erections Cardiorespiratory Changes occur. The ears may twitch and the nictitating A closer look at the heart rate, the blood pres- membranes almost completely rover the pupils of sure, and the respiration of sleeping adults re- t he eyes. Breathing may be irregular, and the eye- vealed no simple and striking increases during balls seem to move in short rapid jerks.This is REM sleep, for the increased levels wire rela- tie picture observed in dogs, cats, rats, rabbits, tively small.The overall nightly pattern, ob- monkeys, and man. Dr. Frederick Snyder of served in a study of 12 young men and women, in- NIMH has recently observed that the opossum, a dicated that systolic blood pressure begins to drop most primitive animal, shows REM sleep.Signs at the onset of sleep reaching a minimum in about

75 2 hours, and rising progressively back to its orig- greater changes in respiration.It is early to say inal level during the rest of the night.Respira- whether the emotionality and violence of dreams tion and heart rate dropped continuously as the are always matched by greater changes in these night wore on (Snyder 1960,1962,1964). outward bodily indicators (Snyder, 1960, 1965). If these cardiorespiratory functions did not The radical physiological fluctuatio ,s that were show large and uniform increases during REM observed by Snyder and others present more of a sleep, they showed another pattern that is perhaps problem than would progressive increases in blood more alarming to the clinician apprehensive about pressure, etc.In hypertensive patients, for in- nighttime cardiac crises.During REM periods stance, it is true that high blood pressure is worri- the systolic blood pressure, pulse, and respiration some, but the more dangerous tendency is often fluctuated, sometimes wildly, an erratic pattern that of sudden and enormous shifts in blood pres- that sometimes sent blood pressure above any levels sure which are hard to prevent and control, even observed during the quiet waking intervals before by sympathectomy or drugs. sleep.(Snyder et al., 1964). Nightlong measure- It is clear, given the clinical ramifications, why ments of pulse rate and blood pressure had been investigators have wanted to obtain very precise taken by recording pulse sounds from a micro- measurements of blood pressure dia.ng sleep. Di- phone taped on tho ankle, and an automatically in- rect measures of arterial blood pressure and blood flated kg cuff, a laborious collection task mat was flow might be obtained continuously throughout followed by an even more laborious data analysis the night by using implanted catheters. This is a (Snyder et al., 1963). The REM periods were, in- difficult and touchy procedure, but it has been ac- deed, intervals of marked variability, a finding complished in the monkey, revealing the pattern that has since been confirmed by other investiga- observed in mangreat variability during REM tors (Kamiya, 1961 ; Shapiro et al., 1964). sleep (Stoyva et al., 1965).Similarly, heart rate Whether this variability is related to the emo- and respiration varied during REM sleep. tions of dreaming, is triggered by excitations from Oxygen Consumption the central nervous system, or by a combination of Some recent findings by Dr. Eugene Aserinsky mechanisms--it is a finding of considerable in- may help to explain this picture. At the onset of terest.Systolic blood pressure, as measured by an each REM period respiration is regular, but it arm or leg cuff, is the pressure of blood expelled becomes shallow breathing. When breathing be- from the heart by its contraction. This pressure comes very shallow, there is less oxygen in the is reflected in the expansion of arteries and veins. blood.At times, during REM periods, arterial In the healthy person with a normal heart, the oxygen saturation drops below the point that a systolic surge is followed by decreased pressure in person would tolerate were he awal-e and holding direct proportion. This is the diastolic phase of his breath. This may trigger an acceleration, an pressure that occurs when the heart expands and increase in the respiratory rate.It is not clear the chambers fill with blood.The intervals of exactly what causes this incredibly shallow breath- contraction and expansion are reflected in the ing. However, there may be some connection be- pulsing of the blood, from which we detect the tween the depth of respiration and the heart rate, rate at which the heart is pumping. The relation in which shallow breathing L accompanied by a between pulse rate, blood pressure, and rate of transient slowing of the heart. respiration is complicated and not well understood. The observation t.f peculiar respiration patterns Variations of heart rate and blood pressure often during sleep, relatively even and regular during occurred during fluctuations in breathing but slow-wave phases, variable during REM perio sometimes they were independent (Snyder et al., led to many questions about the mechanisms di 1964). These occasionally dramatic and sudden mightbecausing them. The consumption of ox3, excursions in the heart rate and blood pressure gen is an important part of the body's energ may oiler a clue to the nighttime heart attack and metabolism, and one method of looking indirect]. cardiac failure during sleep. Many people have at metabolism has been to examine the exchange supposed that violent dreams might bo the cause of inhaled and exhaled gases. This is the basis of of such attacks, and a number of investigators the rough aril ready basal metabolism test which have observed that particularly intense dreams measures oxygen consumption. Dr. Aserinsky has may be accompanied by more eye movements, and used an oximeter, at t Relied to the ear lobo of a well 76 82 trained sleeping volunteer, and a face mask that peratures higher than those of waking arousal. filtered out exhaled carbon dioxide and oxygen. Implants in other brain regions also showed simi- By this method ho found that the oxygen level de- lar temperature fluctuations, but more slowly, creased sharply and reached its lowest levels dur- whereas measurements taken in the skin of the ing REM sleep, a sharp decrease not observed dur- neck and body did not show temperature changes ing slow-wave sleep. This may seem related to the parallel to those of the brain.This suggested that shallow breathing, subsequently found during the forebrain, and particularly the hypothalamus, REM sleep. On the other hand, there was no evi- might be areas in which theis a great deal of dence of pronounced changes in carbon dioxide metabolic activity during REM sleep (Kawamura in the periods leading up to the REM periods. A and Sawyer, 1965). recent study of gas exchange, in another labora- A similar conclusion was drawn from a study tory, suggests that there may be some accumula- of cats.Cats with thermistors implanted in the tion of carbon dioxide in the body during the cortex or hypothalamus indicated the onset of intervals between REM periods. These apparent REM periods with a considerable rise in brain inconsistencies reflect the use of different instru- temperature.Moreover, the rising brain temper- ments, and different handling of the data, under- ature was correlated with diminishing amplitude standable in an area demanding such difficult of the brain waves, suggezi ing that the dimension techniques. of the brain waves, themselves, might give some in- One recent search for the clues to metabolism dex of brain metabolism (Rechtschaffen et al., during sleep by examining gas exchange has tnt- 1965).Once again, judging from notable in- ployed a temperature and humidity controlled creases in brain temperature and their implications metabolic chamber.Thirty subjects have been for brain metabolism, it seems that the REM state studied within this chamber, as they slept through is curiously different from the rest of sleep, bear- the night, under a plastic hood. Air was contin- ing many resemblances to waking. uously pumped into the hood, and analyzed for oxygen consumption and carbon dioxide excretion. Biochemical Changes An initial analysis suggests that there is a relation- Metabolism is, of course, a very general term ship between metabolism and the stages of sleep and perhaps misleading on that account, for body observed on the 14:EG.Oxygen utilization ap- and brain metabolism encompass the multitude of peared to be greatest during REM sleep and least systems that, break down food, air, and other sub during stage 4, and carbon dioxide appeared to be stances into the useful components to provide en- accumulating during the intervals between REM ergy, or construct other chemicals, repair cells, periods (Brebbia and Altshuler, 1965). etc. A host of biochemical transformations are Beginning with the outward sig,ns of eye move- constantly occurring and interacting throughout ments, respiration, muscle tonus, etc., scientists the body, throughout life.Reasonably, inves- saw the clues that the dream state, REM sleep, had tigators have suspected that the peculiarREMpe- certain physiological properties that were differ- riod must be accompanied by diverse biochemical ent from the rest of sleep. Why do respiration changes. Small changes, especially in human sub- and blood pressure show certain peculiar changes? jects, are hard to detect, and offer a technical Why does the gas exchange seem to change? The challenge that often outstrips our present labora- questions have led inward. tory ceyabilities. However, a start has been mule in tha :earth for some of the more relevant and Brain Temperature perhaps related chemical changes, and this new Two laboratories, working independently, have body of work has been reviewed by Dr. Arnold seen evidence that there are portions of the brain "Lindell of UCLA (Mandell, 1965). which rise in temperature during REM sleep. Sleeping rabbits, implanted with small thermo- A number of subjects have learned to sleep with couples in the preoptic region of the hypothala- a catheter in their arm, and it has been possible mus, have shown a waxing and waning of brain to scan the rise and fall of free fatty acids in the temperature, considerable variation during sleep. blood during sleep. These substances reach peak During slow-wave sleep, the brain temperature concentration around the middle of the night end dropped, but it rose sharply during episodes of drop to a nadir before waking. Their variation REM or activated sleep, sometimes reaching tem- over the course of the night may turd out to be 83 77 correlated with the occurrences of REM periods The recent and growing evidence of pronounced (Scott,1964). biochemical changes, coinciding wit i the REM Nightlong blood samplings have been obtained period, may not be knit together for some time to from other catheter-wearing subjects, in order to come, but it has struck off a surge of investigation trace the course of certain stress hormones, the that already shows some clinical interest. 17-hydroxycorticosteroids.These steroids show Erection Cycles a pronounced effect upon the central nervous sys- As people look more closely at the physical tem, and when they are not in adequate production can induce an inability to concentrate, and dreamer, It is evident that the bizarre images, t::e travelogues of the mind, are not the only strange restlessness. They appear to be most concentrated in the blood during the early- morning hours, events of the REM period, but that the entire before awakening, and in lowest concentration at person must be swept by unusual excitations. night, showing a correspondence with the circa- One of the more obvious of these signs is the dian rhythm. The interesting tr.tcern observed penile erection that slightly precedes almost every a study of six subjects was that the rise in 17 REM period in males, from infancy into great age. The phenomenon of nightly erections was °TICS was not grarlir.1, but that it occurred in a described by three German researchers two decades series of jumps during the latter part of the ago as occurring at intervals of roughly S5 min- night's sleep.These tievations came in intervals utes and lasting some 25 minutes.This sounded of 1-2 hours, and there was some correlation with REM periods. Oro pattern was clear for all sub- so much like the dist ributk: REM periods that Ian Oswald of Cambridge University began to jects: The hormone level during the second half of the night was four times the level in the first study the phenomenon.His measuring instru- halfa ratio in striking correspondence with the ments precluded a reliable correlation; however, percentage of sleep devoted to REM, which was a correlation icerween REM periods and erections five times as great during the second half of the has been .c',,de recently by Dr. Charles Fisher, Joseph Gross, and Joseph Zuch at Mount Sinai night.Although these hormone levels may not turn out to play a role in causing REM sleep, Hospital in New York. An initial study of 17 subjects indicated that erections preceded rapid they may suggest one link in a biochemical chain, part of a hypothetical and biological clock that eye movements and lasted throughout 95 percent of the REM periods. triggers the activity we know as the REM dream Recent studies have indi- state (Weitzman et el., 1965). cated that this phenomenon is not altered by recency of sexual orgasm, and it does not seem to Various hormonal fluctuations may be asso- stem from overtly sexual dream content.If 95 ciated with a number of curious bodily changes percent of the REM periods are accompanied by during REM sleep.Some hormones, for example, erection, then the odd dream periods need ex- play an important role within the gastric system. planation.Instances of sudden detumescence Here is another area that has shown some interest- appear to be related to dreams of severe anxiety, ig activity during sleep.Patients with duodenal and total absence of erection may bo related to ulcers, for example, have been known to exhibit fatigue and anxiety (Fisher et al., 1965, Karacan high gastric accretion at night. Very recently a et at, 1965).It has been observed among animals group of investigators looked into the patterns of and man that intense emotional excitement, not patients with duodenal ulcers, with the hunch that their high nighttime gastric secretions might be specifically sexual, can be accompanied by erection. Perhaps this is a discharge overflow from intense related with REM dreaming.Patients and nor- neural excitement occurring within drive-related mal controls all slept with tubes from which centers that are activated in the dreaming brain. stomach contents were sampled, while polygraph recordings were taken. The ulcer patients showed The Eye Movements a significant increase in gastric secretion during 0-,e of the most puzzling of the dream accom- REM periods, whereas the controls had a low pa. intents is the physical signpost by which it secretion rate throughout the night, and one that was detected, the rapid eye movements themselves. did not differ greatly whether they were awake, Why do the eyea move as if they are watching in dreaming, or nondreaming sleep (Armstrong events on a screen or reading] The obvious et al, 1965). answer seemed at first to be that the eyes were

78 84 scanning the dream i Pages. A number of hives- Although the eye movements may be related to tigato.s have reported that there seemed to be the moving pictures of the mind, the response may more actual eye movements accompanying dreams not resemble the voluntary action of vatching of events that in real life would require frequent real tennis game nor even with eyes closed, imag- shifts of gaze (Berger and Oswald, 1062).Sev- ining a game. A number of very different find- eral investigators sought to find out whether tha ings bear on this point.First of all, some of the eyes moved when it person merely imagined scare eye movements recorded during dreaming are so activity.Dr. G. II. Deckert showed a swinging large and furious they would be inconceivable as pendulum to subjects, then asked them to close voluntary movernen`s in waking life. (Oswald, their eyes and imagine it.Their eye movements, 1962).Rapid conjugate eye movements can be when they were imagining the movement, closely caused by artificially changing the electrophysio- resembled the actual watching of the pendulum logical state of the frontal cortex (Rassmussen and (Deckert, 1964). A further study by Dr. Bar- Penfield).Animal studies, primarily studies of bara B. Brown and her associates suggested that cats, have shown that there is considerable elec- the eye movements during such a recall would trical activity in the visual system during REM slightly exaggerate or diminish the original, real sleep where sudden bursts known as spike dis- motion, and that these movements occurred both charges have been recorded from within the brain. in people v-lio deliberately ,:xperience visual imag- Such spikes have been found during rapid eye ery and those who cannot (Brown et al., 1964). movements in the pontine reticular formaticat of

Simil. evidences have come from others (Antro- the brain stern, and in two centers of brain that bus et al., 1964). form relay depots for impulses as they travel from If the overt eye movements of dreaming indi- the eyes and optic nerves toward the back of the cated the scanning of images on an interior screen, cortex and the occipital region involved in vision they might not be expected of the blind, especially (Jouvet ; Michel et al., 1961). the congenitally blind.Drs. R. Berger, P. 011ey, The eyes are, of course, ordinarily important in and I. Oswald found no rapid eye movements or maintaining plijsical balance, although much of reports of visual imagery in the dreams of con- our neural apparatus for adjusting balance de- genitally blind people, although they did exist in pends upon the vestibular system leading from the people who had been blind from 3-15 years ears.Here, too, in spite of the fact that our post- (Berger et a]., 1962).Drs. William Offenkrantz ural muscles lack tonus during sleep, neurons of and Edward Wolpert did see one instance of rapid the vestibular system show bursts of rapid dis- eye movements in a congenitally blind person charge during the rapid eye movements of REM whose dreams were not visual, and recent studies sleep (Rizzi et. al., 1B1). of people with lifelong blindness have indicated Similar bursts of electrical activity have been that they do have rapid eye movements during observed in the visual cortex and in the eye muscle stage one "dreaming" sleep.It would seem that (Michel et. al., 1964). This latter activity did not previous failures to record REMs in the congen- seem to originate in the refina or in the nerve itally blind have 13(.n due to deficiencies in the receptors of the eye muscles, nor in the cortex as recording method. (Gross et al., 1965). one might expect of an imagined vision.Even In 1960, Drs. Howard Roffwarg, W. C. Dement, when extrinsic ocular muscles and eyeballs were Joseph Muzio, and Charles Fisher carefully awak- removed, the pattern of discharges on the visual ened volunteers after particular eye movements, cortex and brain stern remained the same. By and asked for detailed accounts of the dream event. surgical cuts, it was shown that this discharge ac- Another investigator, who did not see the record of eye movements, was given the dream story and tivity did not come from the cortex and descend told to map out and space the eye movements that to the brain stem level.Instead, it seemed to origi- would matchit.These tracings matched the nate in the pons of the brain steh and spread to- actuP1 eya movement record with great accuracy. ward the eye muscles and central pathways of the This work am' further studies correlating eye visual system. motion with dream event suggested that the eyes During REM sleep distinctive discharge pat- were indeed following dream events (RofTwarg terns can be seen in another part of tha visual sys- et al., 1062). tem, the lateral geniculate.The altered firing

79 patterns of these cells do not seem to come frum of the nervous system could be responsible for such the retina, and its nerve routes, but possibly come an implausible interval in existence? Why might upwards from the pontine reticular formation in a brain that wakes ar.d rests fall intu these cycles the brain stem (Bizzi, 1965).This is an unex- of bizarre activity?'What function could such pected link in the brain network that may contrib- a state serve in the survival of creatures as complex r te to the visual imagery of dreaming. as man and as primitive as an opossum ? How does Close readings of electrical potential changes in this dreaming brain appear to behave? the eye muscles during REM sleep show a more Similarities to the Waking Brain rapid and chaotic activity than any seen in wakefulness, suggesting that dream imagery would Probably the most striking thing about, the have to 'te incoherent to produce such a scanning dreaming brain is it; resemblance to the waking pattern.This is, of course, possible. We may brain as judged by some of its brain wave patterns. write the connective scenario of dreams after the The brain is by he means precisely like the awnhe hodgepodge of imagesOne likely explanation brain during REM periods, but it is quite differ- suggested by the data may be that the eye move- ent in its behavior from the brain during all other ments are the result of "electrical" storms gen- sleep. A truly enormous number of studies have erated within the brain during dreaming and emphasized this point ; a good portion of these re- sweeping through portions of the visual system, searches have compared evoked potentials from bearing indirect relation to the visual imagery. a brain site during waking and several phases of Kittens have been reared in total darkness, yet sleep. In this procedure a sound, a light, a touch, have shown rapid eye movements during sleep or some other stimulus is repeated and the brain's (Fishbein et al., 1965). Monkeys have been raised reaction is recorded in the instantaneous EEG with contact lenses permitting some light, but no pattern. This EEG response is minutely analyzed patterned vision, and they, too, show rapid eye and each wave compared for size, duration, shape, movements in sleep (Berger and Meier, 1965).It and latency. Two kinds of findings of especial has been observed that pupil dilations occur dur- interest have emerged from this method. One is ing the REM periods, phasically, but these occur illustrated by readings from the scalp of human in blinded cats as well as normal cats (Berlucchi volunteers who received mild wrist shock. During et al., 1964), and may represent excitation that is waking and stage 1 REM sleep the EEG response not directly related to dream imagery. is similar in shape, etc., close yet not identical. Many facial muscles are spasmodically activated The segment of this response thought to represent during dreaming.This is the time when babies the integrative area of the brain that transform suck or smile, when the cat's whiskers twitch. It sensory impulses into feeling begins to arrive much is the time when people usually grind their teeth. more slowly from stage 1 sleep into stage 4. This A tree of nerves known as the trigeminal nerve suggests that the quality of mentation, somewhat brunches to many fatal muscles, including the akin in waking and REM, must change consider- masseters whose contractions result in teeth grind- ably during deep sleep(Allison,1961, 1965; ing. The motor nucleus, the root of this cranial Rosner et a1.,1963). nerve, is very near to a brain stem nucleus that A sec.md, seemingly paradoxical finding has emits great bursts of electrical activity during been reported by Rosner and a ;,umber of investi- REM periods and perhaps transmits its excitation gatorsessentially that pens ry stimulation evokes to these facial muscles. more of a response during deep sleep than during If dreams are perplexing and strange, it is clear- waking or :EM. Dr. lIeniandez-Peon and his ly a most strange state we are in as we dream. associates in Mexico City demonstrated this odd Our eyes move, we twitch, we may talk or utter fact and suggested an explanation (Tiernan(' !2.- sounds, we breathe shallowly and irregularly, our Peon, 1065).During one study of cats, they re- heart rate fluctuates, erections occur, and at the corded the electrical potential changes from the same time muscle tonus is very low and we are vir- fifth sensory nucleus, a point where a nerve iiher tually paralyzed for short periods, often showing bearing tactile impulses from the skin finally en ho knee reflex (Dement, 1965), while portions of ters the brain.They touched the cat lightly on our brain seem to be suddenly swept with storms of the face. During waking, this touch evoked only sudden, brief activity. What curious organization a small potential in response, suggesting th. 80 86" sensory stimulation was somehow being screened cells do not simply beco:ne inactive during sleep, out. During REM sleep ihe potential was small, but that they dischargA lifferently, , some of them as well.But during deep slow-wave sleep the more rapidly and m _me often.Electrodes im- brain response was exceedingly large, suggesting planted in the visual e,rtex of cats showed that the that any filtering system must be virtually inoper- cells of this area increased their activity during ative. Sensory inflow appeared to be heavily cen- REM sleep, a finding that seems consonant with sored during wakefulness and dreaming sleep. the visual hallucinations of dreaming. Other studies suggest that some of this filtering is The dreaming brain also seems to be hotter than accomplished at the periphery. the brain in other stages of sleep.Moreover, Parallel studies prrforned daring- the late 1950's a, correlation between the changing brain tempera- indicated that t: is censorship might be an essential ture and EEG amplitude has suggested that this ingredient of focused attention. Hernandez-Peon, amplitude may be an index of brain metabolism recording from electrodes implanted in the optic (Rechtschaffen et al., 1965).Thus, it would seem radii. Sons of patients undergoing diagnoses for that high brain temperature, and low EEG ampli- brain surgery, had discovered that the EEGs tude imply a high rate of brain metabolism, and showed a large potential when a light was flashed are an index: to the liveliness of mental activity in in their eyes at an idle moment, but that this poten- sleep and waking. Once again, the dream state tial was considerably diminished if tin patient seems to resemble waking rather than the quiescent happened to be conversing when the light flashed. stages of sleep. The potential declined similarly when the patient Yet another kind of probe into the brain has told did a mental arithmetic problem or tried to recall of some great similarity between waking and REM a past event in his life.It looked as though a sub- sleep.Dr. Heinz Caspars of the University of cortical inhibiting mechanism were at work pro- Munster implanted rats with direct current elec- tecting the individual from irrelevant sensory trodes.Ordinarily., neurophysiologists use alter- inflow during moments of concentration, thus pre- nating current electrodes.Roughly speaking, the venting a chaos of incoming stimuli from sabotag- DC potentials showed a pronounced positive shift ing all focused behavior. During REIM dreaming during slow-wave sleep, but they showed ft nega- and waking such a protective filtering may guard tive shift during REM sleep. DC shifts corre- our capacity for attention, and indecu, protect sponding to the alternating phases of sleep have sleep. since been seen in rabbits (Kawamura and Sawyer, This similarity between brain response ii. wak- 1964). These all indicate striking similarities 1-e- ing and the REM state has been exposed by studies tween brt.'n responses, cell activities and back- of man and different animals, performed for dif- ground state in waking and dreaming. ferent reasons by Everts, Rosner, Rosenblith, A Difference From the Woking Brain Segundo, Williams and Adey, to mention only a One very striking difference between the brain's few. responses in steep and waking has been noticed in Similarities have also been seen in the spon- the great bundle of nerve fibers that connects the taneous activity of brain cells recorded at a time two halves of our brains.All mammals essen- when no ext,:nal stimulus was applied.Dr. Ed- tially possess two brains, joined in the middle by wa ,d Evarts of NIMII has recorded from it( nkeys fiber bundles, the major one being the corpus cal- the activity of single cells in the pyramidal tract, losum that runs down the middle of the vortex. which bears messages from the cortex to the motet. By severing these fibers it has been found that they system. Some cells showed the greatest frequen- play a significant role in telling the right side of cies of discharge in waking, were diminished in the brain what the left has perceived or thought, REM sleep, and lowest in slow-wave sleep. These a major integrating function.Neural cells of the cells showed least variability inwakinff,, but cortex, associated with the corpus callosum, show greatest fluctuation during REM sleep. Curiously intense atavity during attentive wakefulness, pre- r lough, the wild discharge irregularities they sumably coordinating the many activities within offered during REM sleep resembled the pattern the brain.However, Otero is a progressive de- when the waking monkey moved, reached for food, crease of activity in these cells during sleep, and or scratched himself.Evarts and his colleagues studies performed with implanted cats have shown were among the first to demonstrate that brain minimal activity oven during 11FIM sleep. The 87 81 activity of cells associated with this vast fiber sys- were decorticate, may live for several years, bed- tem differ 3onsiduably in waking and sleep, and ridden, staring aimlessly, sleeping only for short may suggest a more subtle distinction between the intervals, unable to see, hear, or follow commands. brain's capability in dreaming and waking (Ber- Jouvet and his associates observed that such :mcchi, 1965). people, during sleep, showed every sign of being After a study of chimpanzees, whose sleep cycles in a REM state but not slow-wave sleep.Slow- and brain responses most closely resemble man's, wave sleep seemed to require descending impulses Dr. W. R. Adey of UCLA. has suggested that from the cortex and was prevented by dezortica- REM sleepis not deep unconsciousness but a tion. state in which attention is concentrated internal- Other accident victims, observed over several ly when the er'er.:.ure is insensitive to peripheral months, seemed to be "unconscious" yet almost stimulationa state resembling those moments permanently awake. For short intervals they when an individual is so wrapped up in thought would appear to sleep, and this was always slow- or in a book as to be virtually oblivious to the dis- wave sleep.There was great muscle activity dur- tractions around him.Although many neuro- ing this time, and tonus very rarely disappeared; physiological studies and especially recut studies there was no sign of REM sleep. On autopsy it of chimpanzees emphasize great differences te- was clear that these people had been damaged at tween the sleep mechanisms of man and those of the lower part of the midbrain and in the brain lower animals, it is interesting to note that many stern pontine reticular formation.This corrob- experimenters working with cats or other animals orated laboratory experhnents with catssuggest- have come up with the same description of REM ing that the knob of neural tissue at the base of sleep as a stat 3 of inward concentration. the brain, the ports, must regulate the REM state, The Neuroanalomy of the REM St,te and without its activity there would be no REM The brain anatomy of the REM state, insofar sleep (Jouvet, 1960, 1961, 1969). as .ve can decipher the puzzle, has been exposed Jouvet and his colleagues lm ve performed in- by a number cf .i.esearchers.It has been explored numerable experiments upon cats to exp'.ote brilliantly by Michel Jouvet and his associates in a precise and refined manner the effects long seen Lyon. Their research on cats, on accident victims in accident victims.By stages, they destroyed Nrit It head injuries, on normal people, has led them small areas of nerve fibers and watched what. hap- to conclude that. dreaming is a unique state, that pened to sleep. When they decorticated cats, the two difiereiii; neural sys-ems innst control sleep animals slept only in the REM phase and no longer and the REM state.In a sense, they have postu- showed the synchronous waves of deep sleep that lated a dream- inducing center in the brain stern seems to emanate down from the forebrain. Many whose activationis associated with the many people, in this laboratory, and elsewhere, had in- physiological changes seen in dreamers. duced sleep by stimulating hypnogenic areas in Occasionally an infant is born with only a brain the forebrain. stem, hydranencephalic.Burins° it has no regu- When Jouvet and his colleagues stimulated the latory mechanisms to keep it alive, such an in- caudal pontine area of the brain stein, however, fant, usually dies very rapidly.If maint:ined the cat would fall into a long interval of REM ardficially, however, this tragic creature, with sleep.After many transections, they found that only brain stem for a bruin, shows EEGs and the caudal pontile nucleus must be crucial to REM rapid eye movements like those of the REM state sleep, for ifit were destroyed, the animal no (Pierce et at, 1965). longer s}'owed any of the characteristic signs in Severe head injuries may cause regions of white sleep. matter to degenerate; this white matter consists 'When Jouvet destroyed the pontile triggering of millions of tiny nerve fibers that connect one center, he found that the animals no longer had part. of the brain with 'mother.Thus a person REM sleep.They were progressively dream de- who is decorticated in an accident is not devoid prived, and showed, in extreme, symptoms remi- of his codes, kt the descending cable system en- niscent of human volunteers in dream deprivation abling voluntary commands to reach the rest of experiments. Many of the animals, for instance, the brain, and thus the body, are now destroyed. became ravenously hungry and obese, and showed Accident victims, who on autopsy show that they serious behavioral disturbances.Many of their. 82 8 8 showed behavior that seemed to be hallucinatory. doxical sleep in laboratory animals. Now, working These animals seemed to be the most telling within this minute region, Jouvet a id his asso- examples of what severe and total T?,EM depriva- ciates are beginning to elucidate some of the pe- tion could do, and of the importance of the pons culiar phenomena N-e have observed in the sleeper, to the dream state (Jouvet et at., 1960-M5). the twitches, and sudden muscular contractions Pecent findings confirming this Aaservon have that occur in an interval otherwise characterized been phrased slightly differently (A. Comacho- by body quiet and general muscular tonelessness. Evangelista and Reinoso-Suarez, 1964).In the Within the caudal pons a small cluster of cells rostral part of the pans there must be structures known as the nucleus coeruleus appears to gen- responsible for activation, for when they are de- erate the inhibition of muscular tone we see duri ng stroyed, there is synchronized rhythm in the brain. REM sleep, an inhibition that prevents us from Within the pons itself, however, some lesions pro- acting out dreams, or moving, even perhaps the duce synchronization while others produce activa- most frightening inhibition, the frequent inability tion, depending upon location, indicating the com- to scream out during a nightmare. When this plex duality of roles played by cells within this rel- tiny nucleus was destroyed by a lesion, the sleeping atively small ; 2gion. animal in paradoxical sleep moved a great deal, In simple, perhaps oversimple, terms, there is a as if acting out a dream. His movements re- small region in the pontine brain stern area that is semble sleepwalking, and indeed, this brain region a part of a system that seems to generate arousal may hold one of the keys to the mysterious phe- by its activity.Characteristically, it emanates nomena of somnambulism. Although muscle in- lowvoltage, desynchronizing EEG patterns. hibition no longer occurred when this nucleus was These are the EEG patterns that are observed damaged, the phasic twitchesof the pupils of the from the cortex and other regions during waking eyes, of the whiskers, etc.remained as usual. and REM sleep. However, when other areas of Is the REM Store Part of Sleep? the brain above this region become active, they seem to generate the synchronous rhythms ob- There is voluminous evidence that the dream state, whether it be known as activated, paradoxi- served in deep sleep, in anesthesia, or coma. The discovery that high activity within a brain cal, or simply REM sleep, is a st ate that differs considerably from the rest of sleep. Jouvet and others stern nucleus seems to trigger the dream state may help to explain some of the peculiar bodily mani- have suggested that it may be a totally different festations at this time.The pons lies close be- state, quite unlike what we usually consider sleep. Moreover. an impressive amount of evidence has neath the limbic system including the hypothala- been summoned to indicate that this peculiar sec- mus.In the human being, roughly speaking, this brain tissue resides just above the palate, above ond state of sleep is regulated by centers in the pens, invoking a quite different set of bzain mech- the roof of the mouth.This system, of which the anisms and consequences than one finds in slow- hypothalamus is part, isASS.Iciated with emotions and instinctual drives.Stimulations here can wave sleep. This has been a strong and appealing produce eating, drinking, rage, pleasure. abhor- hypothesis, and a very frditful one, for it has gen- crated an enormous amount of experimental work, rence.Hy their anatomical connection, excite- which in turn has begun to illmainate some of the ment from the nearby pontine region may spread peculiarities of REM seep. It is not, however, the into this area thus activating some of tlw 1.sponses only theory that attempts to explain REM state, (sucking in infants, erections) associated with the and other investigators have not made up their rudimentary elements needed for survival.As yet uncharted, these paths of excitation may be the minds that slow wave sleep and the REM state physical foundations of drives expressed during are totally different, states, svbserved by two sep- dreaming. arate neural mechanisms.It is not at all surpris- Jouvet's work, augmented by the researches of ing to find control ers-y about this issue, for the sci- other colleagues, has produced voluminous and ence is young, the explora tions recent, a nd the brain elegant evidence that a very small area within the is noted for its complexity and diffusion of func- pons must trigger the electrical brainstorm ars tions.Thus, debate over the autonomy ;)f neural know as the REM dream state.Lesions within mechanisms governing the REM state may con- a tiny region of the pons would cancel out all pare- tinue unresolved, for some time ,89 83 One aspect of the debate revolves around the to produce arousal.Thus, they will explore the differences between higher mammals and man, and possibility that parts of the vigilance or arousal findings that suggest that structures far forward system may be coextensive with the sleep-inducing in the brain, the amygdala, may play a significant system, in parallel, so to speak.If hypnogenic role in regulating the time we spend in each phase cells' activit3 'ominates, there may be sleep; if the of sleep (Adey et al., 1963; Reite et al., 1964; other system dominates, wakefulness ensues. The Rhodes et al., 1965). In cats, during the activated relative excitation strength of these two systems phase of sleep, the hippocampus shows a pro- may dictate our state of consciousness. nounced theta rhythm, and very slight electrical Excepting in abnormal people or animals se- stimulation to the hippocampal region will invoke verely REM deprived, the REM state follows deep the activated phase of sleep (Brown and Shryne, sleep.It occurs in sleep at a time when portions 1964).It has beer suggested that the brain stem of the hypnogenic system hold the balance and in- may exert a less potent influence in higher mam- hibit the arousal system.Balance as conceived mals and man, and the cooperation of phylog,eneti- within the brain is not absolute any more than the c.ally newer and more cortical brain areas may be balance of cone ieling armies or of contending important to the REM dream state. Indeed, it has athletic teams who may shift in their gains and been suggested that the REM state may be a kind losses without any change in the overall score. of rebound activity, interrupting long periods of Within the domain of hypnogenic dominance, re- cortical quiescence and general sensory isolation. gions associated with the vigilance system, among Many people have speculated that the phases of them centers in the pons, may periodically become sleep are the outward signs of a feed back mecha- activated as a part of an organization in which nism, in which the nervous system periodically "at- dreaming occurs and cells associate('ith aware- tempts" to wake up, increasingly often toward ness also become stimulated. Exactly e hat causes morning, yet before it is time for the sleep mecha- internal consciousness, without waking, nobody nisms to relinquish their dominance. Although no can say without further experimentation. one has ever succeeded in finding that the body Neural links have been demonstrated, however, generates a hypnotosin during wakefulness that connectiag peripheral muscle systems, the auto- triggers sleep and is used up in sleep, many people nomic and endocrine systems, with regions of the feel that sleep may be generated biochemically and hypothalamus and hippocampal and amygdala that its alternating phases may represent a neuro- structures forward in the brain, regions that inter- chemical feedback system. act with the cortex.These numerous researches, Another comprehensive attempt to explain the mapping the way impulses travel through portions REM state and some of its properties has been of the brain, have begun to suggest relationships offered by Hernandez-Peon, who with associates between the peculiar state in which our dosed has mapped an extensive hypnogenic system, run- circuit television experience of dreaming may be ning from the forebrain and thalamus, into the related to the physiological signs of muscle spasms, limbic system, with a center in the cerebellum. At eye movements, her and respiration changes several points it may overlap with the arousal sys- (Feldman; Petsche; Yokota ; Parmeggiani). tem. Hernandez-Peon postnlates that the dream The chief EEG signal of the REM phase of state is a peculiar organization of events within the sleep in man is a veryfast, desynchronized sleep system, not independent of it.Future ex- rhythm, containing as one portion a theta activ- periments may reveal whether these two points of ity, accompanied by rapid activity from the cor- view are in total disagreement. tex, a pattern seen most clearly in cats and other By direct electrical and chemical brain stimula- animals in which there has been access to the tion it has been possible to induce sleep along a hippocampus. This slow theta activity emanates hypnogenic pathway, sleep differing in depth, im- from the hippocampas, a region of the brain that mediacy, duration according to the point stimu- has been found to be intimately related to memory latedslow-wave sleep and paradoxical sleep. and emotional function.The universal example The hypnogenic pathway is set into action by of its presumed role has been the epileptic, in whom cholinergic chemicals, but the investigators have damage in this hippocampal area causes severe discovered that cells adjacent to it could be acti- memory impairment.The presence of hippo - vated by noradrenalin and adrenergic compounds campal the in animals diming adaptation to a

84 90 new environment, during periods that might be Animul Dreaming interpreted as anxious and fearful, suggests that Aniaial experimentation, on whic`i we base so these may be intervals in which the animal is in- much of our understanding of man's brain, has capable of taking in too much outside information. al.vay= inspired a certain uneasiness.Animals Hippocampal theta during waking shows contin- show P.EM sleep, that we know, but do they dream uous changes.During sleep, however, it has the as we do? Many people have thought s 's.Pet appearance of a rhythm that is cycling, emanating lovers watch a sleeping dog wag its tail, move its occasionally to other portions of the brain, and paws, wrinkle its nose, twitch its whiskers, or maintaining a regular fast brain wave. This "cir- whimper, and imagine some internal world of ac- cus movement" has been postulated by several ex- tion, p Irsuit, fear, pleasure.Is this creature ex- periinenters (Brown and Shryne, 1964).It may perien ing some visual reenactment of its life? be a fundamental property of the dreaming state, Until recently nobody had e). er taught an animal in which internal information, memory, and feel- to repc'rt "seeing things" in sleep, but this has now ing seem to dominate the inward attention.Rela- been dIrne by Dr. Charles J. Vaughan of the Uni- tionships have been observed between hi ppocanipal versity of Pittsburgh with rhesus monkeys and theta activity, endo:vine function (Sawyer et al., the pruedure will be replicated. 1959), and autonomic and motor activity (Yokota Whi e working on "sensory deprivation" phe- and Pughnori, 1963, 1964).Others have shown nomen , as a grade 'Ai student with Drs. H. Braun that the influence exerted by the hippocampus dur- and R Patten, N aughan helped to develop an ing theta activity may be that of a feedback system, elabon to training procedure.Its purpose was to which opposes the influence of the reticular acti- ascerto n whether "sensory deprivation" did actu- vating system in the sense of controlling the crea- ally pi oduce neurophysiological changes and thus ture's reactivity to the outside world (Lena and cause .iallucinations in animals who, unlike hu- Parrneggiani, 1961; Green and Arduini, 1954; man P lunteers, would not be influenced by verbal Lissak et al., 1962). The relationship between the suggez ion.Rhesus monkeys were nlaced in a hippocampus and other brain regions cr :thal to the booth n which food and water were obtainable, bet avio: a seen in dreaming has been shown by a but in which the environment was severely con- number of studies (Parnieggiani, 1962; Buresova trolled ;the background sound was a constant et al., 1962 ; Feldman, 1962; Manzoni and Panneg- white i oise like a NSaterfall, and the animals faced a grou id glass screen. The monkeys were seated giani, 1964; Jouvet, 1962; Brooks and Bizzi, 1963; in a re training chair with hands and feet resting Bizzi, 1965; Iwata and Snider, 1959). Li essence on a 11 r holding shock electrodes. The monkeys the multitude of studies has shown that hipp- were progressively adjusted to the situation and campal theta rhythm is related to regions regu- trainee to press the bar rapidly every time an im- lating emotion, autonomic, and somato-motor be- age ap eared on the semen; otherwise, they were haviors, and that these hippoeampal rhythms may shockeron the foot.When they reliably re- indeed be spreading from motivational areas in the sponde i to any kind of image on the screen by hypothalamus and may be related to neural pressin ; the bar 3,000 times an hour, they were rhythms there (Petsche et al., 1962 ; von Euler and readyor a 74-96 hour period of sensory mo- Green, 1960; Corazza and Parmeggiani, 1961). notony Although the many interrelationships that have In order to give them a constant and nonpat- now been documented cannot ) et be nieced to- terned leisual field, they were fitted with corneal gether, the many elemeins of this puzzle are being contact lenses made of plastic, and then the door collected througthout the we rld, so that we may of the booth was closed, and the observer could soon begin to see the physical and neural com- watch 1 hrough the window as the monkey sat in isolatio 1.Like the many human volunteer; in ponents of the curious dream state.The function such e:, periments, the monkeys fell asleep soon of the hippocampus in dreaming and in adaptation after the isolation began.During sleep they may indeed suggest a relationship between the showed three characteristic kinds of eye move- dreaming individual, and the individual suffering ments, i slow-rolling movement and rapid conju- from severe anxiety. gate m ivement, sometimes resembling those of a

85 person rapidly scanning the narrow column of sleep or waking? Does the REM state serve some newspaper. vital life function? During these rapid-eye-movement periods, the Surely, in all mammals sleep is distinguished monkeys suddenly began pressing the bar at a by too alternating phases. The curious, recurring frenetic pace, rapidly and regularly as in waking. REM state is an interval of activation in parts of Sometimes they also made facial grimaces, flared the central nervous system, a period that, includes nostrils,breathed deeply, even barked as they dreaming, changes in autonomic functions, brain pressed the bar.Presumably they were "seeing temperature, blood cF.emicals, muscle tension. things" during these intervals of rapid eye move- These many REM phenomena seem to be the con- ments and were avoiding the shock associated with sequence of an integrated neural mechanism, but images.After the isolation period was over, the why such a conglomeration of events during monkeys were tested in the training situation to sleep ?Is this the testin:nny of same mysterious be sure that they still responded reliably to the function without which we would die? projected images.The investigators had seen By degrees, REM deprivation studies of man only one instance of bar - pressing during waking, and animals have aimed to find out how vital so they had little data about hallucinations, but REM sleep may be. If removed from a creature's the evidence that monkeys e:Terience visual im- repertoire would the loss be followed by progres- ages in sleep was very strong. sive deterioration and death? Initial human stud- Further studies using EEG and polygraph iessuggested that psychological changes fol- recordings will be undertaken by others tc cor- lowed fast in the wake of REM deprivation. roboratethis.Perhaps a next steptraining Later and longer studies sometimes failed to show monkeys to respond to particular images or to urn psychological deterioration.Experimenters smells, for instancemay allow us to find out have always been Very cautious about pressing hu- what a monkey dreams about. Although the ques- man volunteers, and whenever ominous signs of tion of animal dreaming has interested pet lovers, behavioral change appeared the study has been animal trainers, and idle spectators, it has real terminated.Although some cats have died after importance for psychology.We have learned 20 days' deprivation, other cats have been pressed very little Arta the interior fabric, of conscious- to very long pei :eels of deprivation, as long as 70 ness in animals even though they are the promi- consecutive days without causing death and often nent instruments of our explorations into our own the behavioral consequences were less severe than behavior. Each demonstrated similarity between expected. experimental animals and man will strengthen the A Limit to REM Compensation applicability of research to humankind. In recent experiments by Jouvet and Dement, The importance of animal research in unravel. it has looked as if the r,!rvous system may have a ling the secrets of the REM dream cycle cannot be safety device after a certain limit of REM depri- overemphasized.To date, although there have vation has been reached. One of the uniform ef- been quite a few human studies, most of our neuro- fects in all dream deprivation studies is the after- physiological evidence has come from examining math, or recovery, in which the individual appears the brain reactions of cats and a few other ani- to be making up the lost. REM time by spending a mals, including monkeys. The data from these far larger proportion of his sleep in that phase, studie.; have arrived rapidly in the course a finally, in the course of many nights. compensat- single decade, inspiring new hypotheses about the ing for the entire loss. This pattern of compensa- natuen, organization, and purpose of the REM tion suggested that REM sleep might be triggered stare.These animal studies have helped to deline- by se me natural chemical that was produced at a steady rate and used up during the HEM period. ate a phase in the existence of all men, all animals, It was assumed that the deprived subject nu =t be that now looks even more elceptional, provoca- payin4 off a biochemical debt.More recently, tive, and anomalous t Inn it may have 10 years ago, however, deprivation experiments with cats have when attention cohered arourd the vivid drettn- suggested that there is a limit beyond which the ing that recurredperiodically throughout the componsatory REM sleep no longer increases. night.Is this a unique state, something we should Jot vet has deprived cats of paradoxical sleep des'gnate as a third state of consciousness. nlike by placing theta on a steno surrounded by water so d6 92 that the loss of muscle tone accompanying tie on- which they no longer reimbursed the REM sleep set of REM sleep would cause them to fall into the they had lost.If such a leak occurred, one might water and wake up. When removed from. this expect to detect the triggering chemical within the perch and placed in a recording cage the animal spinal fluid. would quickly fall sleep, and during the first 6 One method of ascertaining a change in spinal hours it was possible to see how much more REM fluid would be to take the cerebrospinal fluid of sleep occurred than usual.After 24 hours there a severely, deprived animal, inject it into the spinal was a 45 percent increase.After 72 hours there fluid of a normally rested animal, expecting that would be a 60 percent increase, and even after 22 thn recipient would show a sudden increase in days there was never more than a 60 percent in- REM sleep.This is the gist of a procedure that crease in those first G hours of -uninhibited sleep. has been performed at Stanford University under As previous studies with animals and man ha re in- the direction of Drs. Dement and Peter Henry dicated, not all of the recuperation occurs during following the patternof transfer studies :n a single stretch of unrestrained sleep.Af, er 10 pharmacology. days of deprivation F, cat may take. 5 days tc com- Fine catheters were implanted into the third pensate, anal after 20 deprivation days, he may ventricle and cysterna magna in donor and re- take about 10 days, ceiver cats.This enabled the experimenters to Dement, pressing a group of 20 cats to long draw spinal fluid from one, and inject directly into stretches of deprivation found that they. too, the other.The receiver cat was scheduled so that showed the same effect.Until 30 days they ex- his sleep 1.nd amount of REM time became rela- hibited continuous increase of REM sleep in re- tively constant and measurable. The donor cat. covery.However, at about :30 days they se arced was dream-deprived until he began to show be- to have reached a plateau.Even after 70 con- havioral changes, either by constant awakenings secutive days of REM loss they showed no i icre- or by being placed on a stone in a water bath. ments in their compensation, and appeared to pay Then spinal fluid was transferred from the de- back about the same amount they did after 30 r lays. prived cat's brain into the brain of the receiver It appears that the loss of paradoxical ski p is cat.Thera are many difficulties in an experiment never totally reimbursed.If this signifies th t ac- of this sort, and some of the cats reacted to the emnulation of a chemical in the brain, a chemical injections with fever.Nevertheless, after trying that normally triggers REM sleep in the pons, one many pairs of cats the result looks positive.Re- might expect that the accumulation would lead to ceiver cats have been showing a distinct increase in brain stem damage. Surely, after prolonged dep- their REM time after injections of spinal fluid rivation, as shown in Jouvet's laboratory, the from the deprived animal (Henry et al., 1965). cats have exhibited what might be called an ex- The very fact that increased paradoxical sleep has traordinarily strong need for the paradoxical sl telt. has been obtained by transferring spinal fluid from Even under heavy narcosis, they will show p ira- deprived cats into rested ones, raises some interest- doxical sleep.After these long deprivations, they ing questions about the nature of the chemical and have also shown episodes of behavior disorder, the nature of the brain. sleep trouble, and several have died. A hint about the nature of a possible chemical Experiments in the Biochemistry of REM Sleep has emerged from recent studies in ,louvet's lab- What is happening within a person or an'mal oratory.There, injections of a depressant. reser- in whom this recurrent c;cle has been prevet ted? pine, totally suppressed paradoxical sleep, but the Dement and Jouvet have hypothesized that the sleep phase would be restored by an injection of REM state is triggered by a biochemical mecha- Dope.Dopa is related to a familiar group of nism, possibly a chemical that is used up during brain amines and is a precursor to noradrenalin the activation of the brain during the REM Mate. (Matsumoto and Jouvet, M., 1961).Further ex- When a cat no longer discharged this chemical, peciments in this laboratory indicate tint withina perhaps it arenmulated until it reached such con nucleus in the pons that appears to be responsible munitions that it could pass through the brain for one aspect ofRED[sleep phenomena, there are Hood barrier.It might literally leak out of the capillaries suggesting biochemical responsiveness, central nervous system.This might explain why and that the region does respond to tiontdrenalin. the deprived cats seemed to reach a limit beyond Noradr.nalin is sometimes referral to as a neutral

87 stimulant and is released at many sites in the body of reducing brain excitation.Dement, Gulevitch and brain when an abrupt increase in survival ac- and their associates have begun to explore the ef- tivity is required, as when an individual is sudden- fects of electroshock in patients and laboratory ly frightened and must get ready to run. Other in- animals. Initial findings indicate that people show vestigators have postulated that noradrenalin and less REM sleep after Shock treatment, suggesting related neurochemicals may be the excitors in a again that electroconvulsive therapy performs balanced chemical code system, playing the role of some of the same functions as does the REM activating brain regions that, engender vigilance period. and arousal.T' chemicals of the adrenalin family Is REM sleep, then, an end result of a metabolic- trigger REM sleep and accumulate during depri- neural cycle, orwhich is i.ormally discharged vation, one might anticipate signs of brain excita- during waking behavior, but which builds up pe- tion in a deprived creature. riodically during the quiescence of sleep until it REM Deprivation and Brain .Excitation reaches a discharge threshold? Are the psychotics Recently Dement's laboratory has amassed in- who benefit from shock therapy victims of an ab- direct evidence about the brain state of the REM normal metabolism, in whom production is over- deprived animal, evidence that suggests a staeof abundant, or discharge inefficient so that metab- excitement in certain neural centers. A group of olism outstrips the ability to maintain a balance cats, whose sleep was scheduled by placing them within the central nervous system? If so, the on a treadmill for 16 hours a day, were permitted narcoleptic syndrome, with its sudden plummeting to sleep for 8 hours, and were awakened at the onset out of wakefulness into a REM seizure, looks as ofeach REM period, getting only about 5-20 min- if it might be one of nature's makeshifts, a mecha- utes of REM sleep a day. It didn't matter whether nism by which the brain discharges overexcitat ion they endured this routine for more than 30 days; before psychosis can begin. even at 70 days, when permitted free and uninter- The term "excitation" is extremely general, but rupted sleep, they never reimbursed more of their it is probably an efficient desig ition for the state lost REM time than they did after days. How- that is observed. during REM sleep, and enhanc,:el ever, as severity of deprivation increased, it became by deprivation.Insofar as it can be defined, it almost palpable in their REM sleep, for these has been defined by deprivation studies. During intervals grew exceedingly intense,. The animals deprivation, for example, Jouvet has found that were seized with twitches that now appeared al- cats show a marked increase in heart rate that most liko great spasms. The REM temperature settles back to normal after recovery sleep. The change in the brain of one deprived cat was three electroconvulsive seizure threshold drops in de- times larger than his usual temperature rise, dur- prived rats.The intensity of REM intervals ining normal baseline REM periods. creases. This may be related to increased number In another study, after only 4-5 days of REM of eye movements seen in psychotic patients at cer- deprivation rats showed a greater susceptibility to tain periods by Feinberg and his associates.'The electroconvulsive shock.More curious, perhaps, dream deprivation literature probably contains wad their reaction after the shock seizure. They many references to the intensity of REM recovery no longer showed the usual recovery cycle when sleep, although most observers did not emphasize left to sleep unrestrained. They appeared not to these signs because they were concentrating on the need compensatory REM sleep to the extent of amount of REM recovery and other aspects of the the deprived but unshocked rats. Did electroshock procedure. affethe animals' brain processes so as to perfoi in The intensity of a REM. interval has intrigued the same discharge as REM sleep ?Is REM sleep, investigators, who have suspected that. there may in effect, using up the elements of unusual brain be a relationship between the intensity of physio- excitation? logical events, and the intensity of the dream ex- Electroshocktherapy has always presented perience.There have been suggestions that vio- something of a mystery, and there is no good ex- lent, active divatus, heightened psychic activity planation of why it works for certain psychoses. occur at times when the density of eye movements Perhaps its calming function is tnalogous to that is great, when there are sizable changes in res.pira- of REM sleep, and related to the same mechanism t ion, etc. (Becht sclia lien et al., 10G:3; Snyder, 1963).

88 94 A number of people have attempted to knit to- development of drive oriented behavior (Roff- gether data from brain research in order to explain warg et al., in press).The REM cycle doe: , never- how memories, thoughts, images and emotions, theless, persist throughout life.Even if we dis- are built out of patterns of neural excitation into cover that it does not have a role in t he biological dream experience (Fair, 1963; Brown and Shryne, survival of adults, it may promote survival in the 1061; Hernandez-Peon, 1963-65). Although the human being in a psychological-behavioral fashion attention of some investigators has turned toward that would not be as necessary in subhuman the possible biochemical and neural mechanism of species. the REM state, disparate evidence again seems to Human adaptation for survival requires all point to the same expectationif an individual is manner of behavioral niceties, and control over deprived of the releasing mechanism of the REM drive behavior is one of the paramount require- state he may eventually incur a penalty, perhaps ments.As basic drives are intensified, whether creating transient symptoms like those of psy- due to a general excitation from REM loss, meta- chosis, and ultimately causing severe damage. bolic abnormality, or unusual environmental con- It is, of course, impossible to excerpt REM sleep straints, an individual's defenses may begin to from the life of an individual as if it were as dis- break down, possibly starting the concatenation crete as a wart or appendix. Manipulations within of events that occur in the buildup to a psychotic the laboratory undoubtedly create some collateral episode. Even if REM loss were to do no more stresses. Nonetheless, control subjects matched than raise a level of excitation so that a human with deprived subjects, whether animal or human, being found himself losing his usual, carefully have not reacted the same way to awakenings in schooled grip on the expression of instincts and other sleep. impulses, growing somewhat less repressed, his The quality of the response to deprivation has behavior would be maladaptive according to our been respecified by Dement, in recent studies of social norms. severely deprived cats. They have appeared to act Summary as if their basic drives were intensified.Six out of twelve male cats exhibited abnormal and indis- Questions about the possible relationship be- criminate hypersexuality. When also deprived of tween the REM state and mental illness are taking food for several days, the REMless cats acted on a new complexity as data accumulate. Explora- more eager and voracious than their controls. tions at many levels are beginning to delineate They seemed to be too ravenous for food to run why each of us must spend regular nightly inter- a maze with a food reward.Although, in some vals in the dream state ofREM;what is happea- sense, these cats seemed to show an exaggerated ing within our bodies and brains during this so- survival instinct, the various behaviors seen among journ ; what happens if we are deprived of this REM deprived cats, if shown by a human being, weird interval.These explorations are likely I o would certainly place him in the security ward of prove invaluable in the understanding and treatment of mental illnesses, many of which are herald- a mental hospital (Dement, 1965). ed and accompanied by a vicious cycle of sleep The Biological Purpose of the REM State :lisorders. As new data arrive, the questions seem The drive enhancement observed in REM de- to multiply. Yet, in a sense the questions are not prived animai3, the penile erections accompanying new. They have been rephrased. They speak to REM periods in humans, the sucking and mouth- biochemical codes, metabolic cycles, neural path- ing of infants in REM sleep and other data, have ways. Today speculations about the function of suggested to several investigators that the REM REM sleep, and its relationship to mental ill- state may serve its most important purpose for ness, may contain little of the traditional language species survival, by activating the drive mech- of psychoanalysis, and references to surface simi- anisms of the embryo and developing young. larities between dreams and hallucinations seem Perhaps, as Roffw..rg, Mitzi°, and Dement have to have been upstaged by compelling physiological suggested, the REM cycle in adults is an atavistic investigations.Nevertheles.s theories about the remnant, a brain activity «Ii ,50 main role was to psychological content of dreams, their relevance gear the individual for survival by inciting the to our behavior, and the role they play in our

75S-027-- 05-7 89 conscious all stand to be elucidated by these phys- of a psychological process.Unlikely as it would iological studies.Although information about have seemed 10 years ago, these div Irse researches biochemical or neural mechanisms are not ad- are suggesting why we may discover certain per- dressed directly to the subjective adventures of vasive themes expressing basic drives in the dreams dreaming, they describe the physical founeiatioms c2 all men, and perhaps someday, in all animals.

90 Sweet babe in thy face Soft desires 1 can trace Secret joys and secret smiles... William Blake

Chapter VIII. The Development of Infant Sleep

Almost all autobiographies begin as close to the the maturation of the nervous system and to learn- beginning as the author can remember, with a ing? What neural apparatus is necessary before drama performed in early childhood in which he an infant can begin to stay awake for long periods participated, the story of his molding, the expla- and sleep for long periods?What does the decline nation of his metamorphosis. As we try to ex- of REM sleep tell about. the maturation of the in- plain, more systematically, the forces that share fant's brain?Can the brain wave patterns of in- behavior, to understand the process of develop- fant sleep serve as the earliest indicators of normal ment, we find ourselves looking for the earliest or abnormal development? cues in infancy.But the young infant says little Since the 1930's babies had been known to sleep about himself in behavior, and furthermore, he is for roughly 50 minutes at a time. Within this in- almost always asleepone reason why studies of terval there are minutes of slow, even breathing and infant development are now including examina- quiescence, alternating with periods of fast uneven tions of sleep patterns.The EEG patterns of breathing toad restless motions.Dr. Eugene Aser- sleep reflect activity of different neural structures insky wr.tched from the cradle side for a relation- in the brain and these may tell a good deal about ship between slow rolling eye :noveme,nts and body the maturation process of the brain. motion, and in 1952, when he transposed his study The infant's sleep t:iffers from an adult's in sev- to adults, discovered the rapid eye movements that eral important ways.During his first weeks of signify dreaming. On repeated inspection, in- life a human infant is asleep two-thirds, f the time. fants also showed rapid jerky eye movements in Unlike 1 is parents, and often to their chagrin, he sleep, and although wt, cannot imagine that the does not sleep for one long siege at night, but newborn infant experiences visual dreams, he ap- rather for short intervals, interspersed with brief pears to spend much of his sleep in the REM state periods of waking, a polyphasic pattern that is (Dreyfus-Brisac et al.). characteAstic of all newborn mammals. This Judging from what we know now abort, the cycle slowly changes, and he remains awake for BEM state, as it may emanate from tivity longer periods and begins to sleep as his parents within the brain stern, exciting neart , ns do, usurAly to their great relief.From the begin- associated with drives P. nd emotions in I ii. ning the infant has had them at a gr. at disadvan- system, it might be called a primitive at,y of tege, for he would awaken them easily enough with a primitive brain.The sleep of high amplitude, a yowl for food or attention, but in tants are not so synchronous waves seems to depend upon the (cor- easy to arouse from sleep.At first, and to a lesser tex and higher regions of the brain, as we have degree is they mature, infants are very often in a learned from decoticate accident victims and REM stage of sleep. transected cats who no longer show slow-wave A nt.nber of anatomical studies on animals and sleep. behavioral studies of human infants have been di- The Decline of REM Sleep With Age rected coward answering an important question: The regions associat:-1 «ith BEM deep seem to Can w7 relate the maturation of sleep patterns to develop long before the cortec: in its tinny folds 97 91 and convolutions.In the embryo, the nervous the REM state dropped slightly, and in early system begins from nothing more than a tube of adulthood rose slightly, ranging betw)en 20-24 neural tissue.At the tail, the tube begins to form percent, again beginning to decline after about the spiral cord.At the head, the tube bulges into age 45 to about 13 percent in some of the aged a forebrain, a midbrain and a hindbrain, and persons studied.This is a very approximate slowly these rudimentary bulges enlarge and fold. schedule of the proportion of REM sleep occur- Slowly the cerebral nemispheres form, and last ring at any given age, but it suggests a develop- of all, during childhood, the outer layers of the mental pattern of neural activity that begins in cerebral cortex acquire their final convolutions. the cradle and follows a regular curve throughout The hindbrain and midbrain develop long before life (Fisher, 1965). the cortex and before the elaborate fiber network A normative study of infant sleep may tell of communications is established between the cor- whether the decline of REM sleep is so precisely tex and the rest of the brain.Can we infer some- correlated with age that it might be used as a meas- thing about the rate of cortical development in an urement. in infant di.Ignosties.Such a study, be- infant by watching his sleep, particularly the de- gun in the UCLA laboratory of Dr. A. II. cline of the primitive REM state? Parmelee, will encompass systematic observation Only recently a number of investigators have of 100 infants from birth into childhood. New indicated that the REM state does decline in in- techniques for recording heart rate, EEGs, muscle fants as they mature (Parmelee et al., 1961-65; tone, temperature, and respiration now permit such Roffwarg et al., 19E3). By observing the sleep measurements even on very young infants and the of young infants at progressive stages of devel- premature..Recordings are being taken within opment, they have all noted that the proportion the hospital nursery as soon as it is safe and com- of REM sleep declines during the first months of fortable for the baby, who is also watched by two life, a clue that may help the pediatrician to chart observers.Once they leave the nursery the in- the maturation of a baby's central nervous system fants will periodically sleep in a special recording and diagnose such abnormalities as retardation or bedroam where they can be ateoli-ipanied by their schizophrenia at a very early stage of life. mothers. Then, as soon as they are old enough, It is interesting to note that monkeys follow n they will receive graded batteries of behavioral similar course. A recent polygraph study of new- tests at regular intervals. born and infant rhesus monkeys indicated that An initial study of 46 infants has indicated the for the first 7 days of life, the infant sleeps more, progress of the shift from polyphasic sleep to a and a large proportion is REM sleep.After this diurnal pattern.This shift toward nightly sleep critical seventh day the proportion of REM de- occurs in infants by about 16 weeks, even though clined although total sleep time remained rela- they spend no more than about 3 bouts awake in tively constant throughout the first year (Meier any 24 hour period (Parmelee et al., 1964). and Berger, 1065). Initial studies of premature infants, who must From sleep studies of people of different ages complete their embryonic development outside the including a premature infant born 10 weeks early womb, are beginning io show us something about and an old woman of 100 years, we can see ap- the brain activity of the maturing unbornVery oximately how much of one's sleep is spent in premature infants (born 10 weeks early) do not the dream state as one moves through life's time- show an EEG pattern like that of the full term table.In an infant, 10 weeks premature, 80 per- baby. They seem to alternate between one state. cent of sleep was REM sleep, but this ratio of drowsiness and another, and to exist in the REM dropped as the infant approached full term, and state predominately.By taking EEG tracings in infants arriving only 2-4 weeks early the percentage of REM had dropped to 58 percent, and during a 12-hour period of sleep, one such infant was 50 percent in the full term neonate. By 5 was observed to spend SO percent of his time it the weeks REM sleep occupied only 40 percent; by a REM state.IA ss premature infants (Co 7 weeks year only 35 percent ; by 2-3 years, it had dropped early) spent only 6i percent of their time in REM to 30 percent, and by 5years.,20 percent. and the full term infants about 50 percent. By Throughout later childhood and early adolescence, S months of age, this percentage dropped to 24 according to the limited observations available, percent.

92 98 This steady and rapid decline, in REM time was and showed the spindling of sleep much later than noted by Dement, Roffwarg, and Fish ; studies the kittens with convoluted cortex, mature r brains. conducted by watching the eye movements of in- This difference appeared in behavior as well. The fants in the nurseries of Chicago Lying In and more mature kittens snuggled against their mother Columbia Presbyterian Hospitals.Infants of and sought milk in a purposive fashion. many mammal species also have been observed to Roughly, as they observed kittens through the spend less sleeping time in the REM state as they first 6 months of life, the Scheibels began to see matured. What might this decline of primitive EEG progressions that differentiated the "nor- activity mean in the anatomy of the developing in- mal" kittens from those with developmental dis- fant brain?Could it mean that the grossing ten- turbances. At what stage in a kitten's life, or in tacles of the cortex are beginning to gain greater a human infant's life, does brain development per- contact and control, and that the be 'n stern is mit some voluntary control over waking? Is this diminishing in its dominance? a stage at which infants begin to shift to the Cortical Development In Kittens diurnal sleep pattern of their parents? The Schei- bels have performed conditioning experiments to Some suggestive answers have been coining determine at what age 'a kitten might learn to from the anatomical and behavioral studies of Drs. awaken.Kittens were trained to wake up and Arnold and Madge Scheibel at UCLA. They reach for a bottle of milk when their names were have been engaged in a long program of reudies called. of kitten development, seeking the concomitants The first kitten was tested by calling his name of gross behavioral maturation within the growing during slow-wave sleep when he was 68 days old. neural fibers of the brain-The newborn kitten His EEG gave no sign of arousal. When the test has a messy EEG and it is hard to tell whether was repeated at 117 days of age, the kitten's brain the creature sleeps or N:akes.As it grows the wave pattern quickly showed the desynchronized EEG begins to show differentiation, correspond- pattern of arousal, and he got up and began to suck ing w ith the growth of nerve fibers.Dendrites, at the nipple.However, he gave no sign of receptor fibers of the cortex, can be stained con- arousal when a meaningless name, one he had veniently, although the transmitter fibers, axons, never heard before, was called.However, between cannot.Consequently, the dendrites or receivers about 0 weeks of age and about 16 weeks, the have been the first to be rtudied. kitten had acquired the capacity to control his The dendrites of the newl)orn kitten are very awakening. simple. They resemble plants with a single smooth The brain matn ratio:. of the kitten was clocked root, incapable of multiple contacts with other in yet another way, by direct stimulation of the cells. Within the first days of life these dendrites reticular formation, the arousal area of the brain. begin to sprout long strands in many directions, Kittens, implantrei in the reticular area and other giving more surface for contact with other nerve deep brain sites, vere stimulated during sleep at cells.These fine rootlike spines grow mere nu- different ages.Newborn kittens (lid not awaken merous and dense with age, putting out side excur- to rapid pulses; they only awakened after slow sions that may indicate multiplying contacts be. stimulation to the reticular formation.Moreover, tween the cortex and reticular system. their EEG respome to brain stem stimulation a The Scheibels have used pairs of litter-mites in pearod to fatigue quickly.After two repeated their studies, recording the behavior and EEG stimulations had aroused it further stimulation measures of one kitten and simultaneously study- failed to awaken the kitten.Similar berm for is ing the brain tissue, of its filial-nate.Within the seen among humor infants, who do not arouse same litter they found that kittens varied Con- easily from sleep. The Scheibels have conjectured siderably in their rate of maturation. Character- that the undeveloeed enzyme systems of the new- istically, the slow kittens were born with slloother born brain cannot supply the rudimentary mural brains, an archaic and unarticulated cortex. The contacts rapidly enough, and so after these nerve kittens who showed rapid development were often cells fire a few times, the supply of chemical trans- horn with a more mature cortex, and their EEG mitters may bexhausted.Lack of neurechem- patterns differed Conimensurately. The smooth- ical supplies anal explain why the infant can do brained kittens gave slower rhythms in waking what no adult Ca a dodisregard repeated stimu.

99 93 lation direct to the arousal centers of the reticular phasic sleep resembling that of the cat toward formation. the strong diurnal rhythm of adult mar. This rapid adaptation to stimulation, internal Diagnostic Possibilities and external, is a talent that the infant loses with maturation, just as many of tLe sensitivities and The gathering of normative data and the proc- talents of the human childare,likeeidetic ess of inference from animal studies to human de- imagery, lost by adulthood. Theseem to development are both very slow and expensive, but cline during the very process of maturation by there is reason to hope that they will be exceed- which voluntary controls are gained.Experience, ingly useful in diagnostics and for an understand- itself, appears to be the teacher in a very literal ing of the integrity of nervous function in infancy. sense, for repeated experience appears to alter the The common story of mental retardation and mal- brain tissue and make it more responsive. function is a tragic one, in many cases because it Ordinarily, experience does not come by elec- is detected ]ate in childhood development when trical stimulation of the brain, but this is a kind remedies are less and less potimt and more elabo- of artificial experience.Brain stimulation does rate. What amounts to mental retardation in late cause observable changes in the brain tissue of the childhood could sometimes be prevented by the kitten. Niurons connect with each other by sprout- detection of a simple yet ramifying defect, during ing boutons at the ends of their axons.These babyhood, which sometimes amounts to poor visual boutons then contact the receptor filers, or den- control, hearing, or to an insufficient rate of devel- drites, of other neurons.After electrical stimula opment that ends up in leaving a person totally tion in an area, these boutons swell in size, and behind.If such defects can be spotted in earliest enlargement that can be seen under the microscope. infancy remedies can be applied at the time when The engorging of these boutons may be an accum- they -isiil do the most good, for each successive ulation of fluid, perhaps trapped by increased stage of development hinges to some extent upon sodium ions.Similarly, it is supposed that after the last. repeated stimulation an axon will grow in size and Unfortunately most abnormal behaviors are dif- in its capacity for transmitting neural messages. ficult to see in young infants. Many pediatricians Until now, the impact of experience, or stimula- have had the feeling that activity patterns in the tion upon the size of these contact fibers and links newborn can suggest the maturation progress that has been seen only after the fact, by placing speci- will follow, but infant behavioral tests are in- mens of brain tissue under the microscope.Now, adequate.Psychiatrists have reported that ex- however, an exceedingly elaborate microscope sys- tremely underactive or overactive infants seem tem with powerful lighting may make it possible possible candidates for childhood schizophrenia. to look into a living cat's or monkey's brain and When such babies are brought into clinics they watch the brain cells change as the animal is stim- often have a history of unusual sleep patterns. ulated by repeated touches, lightflashes, or Either they seemed to sleep too much, or they soundsIf the technical obstacles are not insur- harried their mothers by crying incessantly and mountable it may be possible to see into the brain sleeping briefly and irregularly.If the norma- and watch it grow during experience. tive studies of Dr. Parmelee, and his colleagues Here we may begin to see the anatomical prove fruitful, we may have another yardstick for changes, the neural growth that underlies the normal development in the rate of REM decline. changing EEG patterns and behavior of the infant Infants who are very slow in this decline may animal. By inference we may begin to under- suffer metabolic problems, causing what we now stand what we are now observing from the surface, call retardation, in a form that can be ameliorated as we study the EEG changes of developing hu- before there are lifelong ramifications. man infants during sleep.Perhaps we can begin Recent designs for extremely sensitive poly- to track the connections sprouted in the growing graph equipment may indeed permit Parmelee brain between the cortical areas and (he reticular and his group to trace the development of infant formation as we see maturing activity in the re- sleep patterns bacit into the womb, allowing us to duction of REM deep, and the growing dominance track the brain activity and physiological develop- of slow-wave sleep as well as the shift from a poly- ment of the unborn.REMactivity may indeed 100 94 represent the first concerted workings of the brain, may be the first expression of all the forces of sur- a fundametita& rhythm into which all later activ- vival provided by natur3 within the ery cells of ity becomes knit, the first pulsing from which the primitive brain, the first practice of the funda- experience and growth will shape the growing mental instinct and drive centersand their first psyche.The dream state of infants, while unlike effector actions, seen as the sucking, smiling, kick- the subjective and complex dream of the adult, ing of REM sleep in the newly born.

101

95 ... others are Incubi or Succubi, who punish men in the night .. For Satan himself transforms himself into various shapes and forms; and by seducing in dreams the mind, which he holds captive, leads it. . The apparitions that come in dreams proceed ... of an intrinsic local motion in the head and cells of the brain. And this can also happen through a similar local motion created by devils. Malleusfaleficarum Dreams which have come to pass are always predictions which no one can doubt, no account being taken of dreams which are never fulfilled. Voltaire Maybe the wildest dreams are but the needful preludes of the truth. Tennyson These whimsical pictures, inasmuch C,,,5 they originate from us, may well have an analogy with our wizolelif e and fate. Goethe The interpretation of dreams is the royal road to a knowledge of the unconscious activities of the mind. Freud

Chapter IX. The Meaning of Dreams Unleashed from reaso and detached from cir- dream books including codes for gamblers and cumstance, the play of dreams is armed with ter- advice on all aspects of practical life are abundant rible freedom. In al, histcry and every recorded on newstands today, we tend to probe dreams for culture the mysterious and evanescent dream has insight into the dreamer. been taken seriously. Strategic dream interpreta- Dramatic, recurrent, universal to mankind, the tions have altered the course of nations, as did dream is nevertheless an experience that people Joseph with the fat trine and lean.Oracles cannot share. Tho dream that is communicated is dreamed the future.By pagan dream rites the a memory from a sleeping state and the extent to sick were healed.Lincoln's dream of death which people must distort their dreams can bo seemed a harbinger of his fate. American Indians estimated by the imperfect, court testimonies of enacted their dreams. Daring the reign of terror witnesses who are attempting to report real events and superstition from the 12t1t through the nth trio! There have been a number of at- century, Western Europeans fought an interna- tempts in ascertain the memory span for dreams. tional conspiracy of witches, and the seriousness One. an initial shady in the University of Chi- of the dream was evident in the Malleus, guide cago, by Drs. Edward Woipert and Harry Tros- and handbook to every judge of the Inquisition, at Man, showed that volunteers could remember a time when dreams might. mean burning. Dreams dreams if awakened at the end of En periods, also inspired poetry in Coleridge, fiction in 'Hobert but not. several minutes later.Like tile trace of Louis Stevenson, and Kekule, the orpnic chemist, the evanescent neutrino, the. dream had to be cap- is said to have deciphered the art.:lige/11( nt of tured at once or it evaporated. atoms in the benzene ring by a dream of a :make A p,yellialrist, whose patients were awakened eating its tail.The skillful man, said Emerson, in this laboratory, compared the immediate :tar- reads his dreams for self-knowledge.Although rat ives with the pat lents' day t imc recollection, and 96 102 found that the morning versions were palpably more vivid and emotional his dream reports, the different. Similar discrepancies were noted at the easier Ins recall.Then, after about 7 hours of Institute for Dream Research in Miami, Fla., sleep, th 3 volunteers began once more dreaming of when monitored records from laboratory awaken. current alements in their lives. Work in progress ings were compared with the written accounts by at NIM H may illuminate the interesting corre- the same volunteers at home (Hall and Van de lation bt tween low temperature and drean of past Castle, 1964.)The laboratory narratives were events, end may determine whether the particu- long and incoherent and less intense than the larly vet id dreams are associated with tires of day, tightly organized home reports.There is no time in 'eed, or body temperature (Verdone, 1965). means of checking a dream report against a dream. As a treat many researchers have demonstrated, However embroidered and shaped, however cen- the RE:q dreams are not islands of imagination on sored and skewed, we have only human recall for a dark river of oblivion, for when people have evidence. Until recently the dreams reported were been wekened between RF1I periods they have usually the last of the night, just before awaken- offered wisps, thoughts, fragments, and images. ing. Perhap these provide continuity among the REM With today's electrical recording equipment it dreams of the night.Drs. Allan Rechtschaffen, has been possible to sample the night's dreams. Geraldogel, and Gerald Shaikun have collected Customarily, volunteers will spend several nights interme liate recollections from subjects and found in the laboratory, adjusting, while the investiga- that th )e non-REM elements resembling day- tor obtains EEG recordings that roughly indicate dreams or imagistic thought may be interwoven the individual's timing and spacing of dreams. into tilt REM content, demonstrating some con- He can predict when the subject, will begin dream- tinuity n the thematic -fabric of the night.It is ing and approximately how long each dream pe- interest ng that people talk throughout their night riod will last, awakening the subject toward the ofslee ),and not only during REM dream end of a segment. (Rechts :ha (Ten, Goodenough, and Shapiro, 10G2). Is there any relation between the several dreams Studiesf sleep talking indicate that it is a com- of a night?Freud suspected that sequences of mon Get arrenee and that it changes in tone, grow- dreams elaborated the same motive, timidly at first ing moi e expressive and emotional during REM and then more distinctly. Franz Alexander pos- periods. tulated that successive dreams were connected in influenc;ag Dream Content pairs, and that a night's preoccupation was clari- Drear ring animals and people are incorrigibly fied by the repetition of a theme.Drs. Harry wrapper up in their private worlds and are usu- Trosman, Allan Rechtschaffen, William Offen- ally par 1 to awaken. Freud and others have 2os- krantz, and Edward Wolpert studied 2 young men tulated ,:hat the dream protects a person from for 32 nights. Well over a humireci dreams were awakeni ng and that outside events may simply be collected and analyzed, bet only on one night (lid incorpot ited in the dream. While working at the subject have four dreams directly related in Un;vers ty of Chicage), Dement. and Wolpert theme and content. The Ltd: ef continuity found tested d reaming volunteers with lights, sounds, in an earlier study by Dement and Wolpert did water.The stimulus was identifiably incorpo- not outlaw the suggestion that a sustained emo- rated in only 20-00 percent of the dreams, but per- tional tone and recurrent items might pervade the haps more of the dreams did interweave the out- night, and continuity was observed by Offenkrantz side disturbances in transmuted or symbolic form. and Rechtschaffen (Offenkrantz and Lechtscha f- (Dement and Wolpert, 1953).I3y objective as- fen, 1963). ses...met t, however, Berger did find outside events The possibility that dreams might have predict- highly incorporated in dreams (I3erger, 1963). able and charnel eristic differences at different The fact, that. we may not incorporate outside times of night. was punned by Dr. Paul P. Ver- events into our dreams 100 percent of the time dune, who found that the initial dreams seemed to does rot mean that we dont interweave these revolve around current events, whereas dreams of events some of the time. After applying heat or childhood and past events occurred later, coincid- cola t) sleeping subjects, investigators have ob- ing with the time, of the person's lowest tempera- tained thermal references in only about 25 percent. bare.The longer a person had been asleep the of the subsequent dreams. Because the incidence

17?..4 +;7i. 10 3' 97 has been low in some well designed studies, there did indeed move their pillows and scratch their has been a tendency to fed that external events do noses. The others either gave no response or not influence dream content very much.Simi- awakened. This difference in suggestibility, evi- larly, bodily s'a t es such as hunger and thirst, have dent in sleep and waking, is a curious phenomenon pre laced little impact on reported dreams (De- (Cobb et, al., 19G5).People differ quite as sharply ment and Wolpert, 1958).However, thirsty sub- in their ability to remember dreams. jects, deprived of food and liquids, and then given Dream Recall a spicy meal before sleep, have referred to thirst to Ten years :too it was possible for a perso a deg,ree that suggests a definite somatic influence remembered dreaming every night to lookth on the actual dre,im content (13okert, 19G5). pity on the impoverished soul whose nights were There have been a number of attempts to ma- devoid of imaginationthe person who said, "I nipulate the content, of dreams.Dr. Johann never dream." Now it seems clear that we all Stoyva of Langley Porter Institute, San Fran- dream about the same amount, every night. Why cisco, assigned several volunteers dream topics by do some people not remember?There have been posthypnotic suggestion. When awakened and many speculations on this point.Patients in asked their dreams, only one or two dreams would analysis, motivated by questioning, begin to re- contain these preassigned elements, which were in- member dreams.Personality differences have structions to dream of climbing a tree, etc.The been discovered in which introspective people notable effect, even with a well seasoned labora- have seemed to recall dreaming most easily.The tory volunteer, was a reduction in the amount of question of dream recall prodded Drs. Donald dreaming (Stoyva, 1062). Goodenough, Arthur Shapiro, and their associates Manipulations of dreaming behavior have in- at the New York Downstate Medical Center into terested many researchers, for individuals differ a long program of studies. Many facto,`,,,.ro at greatly in their responsiveness, perhaps indicating play.For instance, the faster a persoi far-reaching constitutional and psychological en- the more folly he would describe a (-1, r dowments that would be useful to define.In mode of awakening mattered (Ship , studies already cited, some volunteers were able to 1963).However, individualsdiffen the hear and remember tape-recorded numbers while amount of noise that would awaken Ile dreaming, sometimes incorporating them into who normally remembered dreamiie7 their dreams; others could be motivated to press would awaken quickly in the labor ten switches when entering a dream period or respond horrendous 80 decibel blast, and lee to signals.Reehtschaffen, at the University o dream narrative.People who rarely i Chicago, has paid volunteers to increase or de- dreaming at home, when aroused crease their amount, of dreaming with a small ef- nese, often thought they had been fect on tlia amount of time spentin REA thinking the whole time.One young (Rechtschaffen and Verdone, 1961).In each in- erect a bizarre narrative. abaft sitting ill . stance one might eypect that individuals divide ping pennies into a vending machine e sharply in tin ir responsiveness. Dr. Mart in Orne, oilyet asserted he was thinking. 11, and his associates at the Institute of the Pennsyl- t rol his dream, he explained, in the eeir vania Hospital, larebeenconducting a program of daydream, and he was aware of se"nd- studies on hypnosis, and in a recent pilot study room, such as the air conditioner. i find that deeply Lypnotizoble. subjects can act explanation and a wealth of other upon suggestions delivered during dn'a111 periods, that there might he distinct. physioh whereas less hypnotizable people will not follow ences; some people dreaming at a I sleep instruction.During sleep, with no prior normal level of sleep and thinkine hypnntic sugge,tion, volunteers were told that the awake, while others dr am in a dui, word "pillow" vonld make the pillow seem un- mat stage of Eke'', ated lose their di.. comfortable and they should move it; the word long process of awakening.But t11. r "itch" would cause their noses to itch until they he another kind of forgetting as s:.ratelied.When the instructions came. during represien(Shapiro etal.,1901: BEM dreaming, the deeply hypnotizable subjects et al.).

98 104, Dream Intensity drama of monsters, or crime. and violence, just Some guidelines have emerged during the la it before bedtime.In studies of the impact of mass few years for estimating the emotionality of a media on children, some social scientists have pos. dream from physiological pleasures.Dr. Fred. tulated a direct influence on behavior.Dr. David crick Snyder of NIMII and others have corre- Foulkes, when at the University of Chicago, lated physiological changes with dream content. sought another approach and looked for the influ- One sign that suggests an intense dream is high]; ence of presleep stimuli on dreams. From its irregular respiration, like the breathing ofa, roots in a sociological interest, the study then took person in terrible anxiety or impatience.Dr. on quite an independent aspect..Adult volunteers Charles Fisher of Monnt Sinai Ilospit,1 has watched two different films on two separate nights shown that penile erections accompany almost all before retiring in. the laboratory. These were net- dreaming periods in males, from birth on, and work telecasts, one a typical western, the other a dreams that are not accompanied by erection or romantic comedy. By sifting the dreams for in- which have sudden &tumescence appear to be corporation of the previous TV material, the inves- dreams of terrible anxiety, of violence and body tigator found direct influence in about 5 percent mutilation.Some thousands of nights have now of the dreams.Flowerer, when he analyzed the been dreamed away in sleep laboratories, and emotional qualities of the dreams he found that the many investigators have observed physical symp dreams following the western were far more vivid, toms that suggested an intense dream, only to find imaginative, and highly charged than the dreams out when they awakened the person that ho did following the comedy. The results of this study not remember, or only gave a vague and bland (la not conflict with the Downstate study, for the story. investigators used the kind of films a person might normally watch before bedtime.Witkin and Stimulation Before Steep Lewis enr)loyed traumatic and bloody films among Investigators at the New York Downstate Medi- gieirs and were particularly interested in the met a- cal center are cucrentlyNVatelliillir the physio- phors by wltich an individual might transform logical symptoms and EEG configurations of material.For instance, a doe --r of taking cake vtlunteers who have peen exposed to films before from a bag appeared to be cavilconnected to the sleep. On one night there is a pleasant, neutral birth film the subject had seer a few hours earlier. travelog. On other nights there is either an an- We know a great deal more about dreaming to- threpologicaldocumentary shi,wingbirthor day than we did in Freud's time. We Inow more initiation rites, both quite disturbing.In a pre- about the amount of dreaming in in(lividuals of liminary study of 10 people, Drs. Herman A. specified age, physiological chang,.s that occur at Witkin and Helen I3. Lewis, found evidence that the same time, the effects of drugs, sonic of Ilia the elements of the presleep film were identifiably neurophysiological events. We can evoke behav- incorporated into the dreams of that night.By ior in (hymning and compare responsiveness and interview techniques and prior clinical informa- recall. We find that recall differs as the night tion, tic.A investigators have been aide to connect wears on, improving toward morning. 'We may the way the person dreamed about the material soon nnderst and the hics;liontistry that triggers with significant events in his personal life.The dreaming.All of our obsercat ions ;1!`ollt the need subjects were transit Workers, telephone engineers, to dream, the intensity of i'reams, and how their bakers, airplane, factory workers, and oth,:3 who incidence varies with re bound tot/6 refined. normally sleep during the day, and V, ho had not But the meaning of dreams ? been exposed to theories of psychology.Further Grand and confident theoi:les become more diffi- studies using these films; may discriminate between cult to compose as the data accumulate, for today's thos,:, people whose inability to recall dreams is theoriesrequirepredictability,demonstrations relate.1 to physiology, and Om.who ,'ato.,',t re that the relationshipshetWC011 dream and dreamer menthol. disturbing experience:. aro nit subject to the vart ing interpretations of )(any people have wondered w bother a film si en investigators.Many of the dream reports ob- before sleep has an influence on one's dreams. tained in the laboratories over the last In yeas Many parody have fv1:ed themselves que,t1011 differ fri an the types of dreams analyzed by Freud as their small children gave rapt at tentIon to a TV and others, yet many investigators feel that some

ao5 99 of those early intuitive analyses were, in some This empirier.1 evaluation of dream content is sense, true.What beast is loosed at night from based on a systematic categorization of each ele- the cage of civilization to stalk through stark and ment or event.Dr. Hall and his associates have perplexing dramas, perhaps cloaked in innocuous first classified items that occur most frequently: symbolism? how are these figments related to the kinds of characters that appear in dreams and the day past, to the core of the personality, or to their relationship to the dreamer, the setting, the random noises in the bedroom?Does in obses- objects, the dreamer's emotions, lucky or unfortu- sional nightmare relate to neurosis or physiologi- nate events.Out of these analyses, they have cal changes, are there dreams characteristic of developed manuals that might be usr:.d by a thera- health, and dreams bespeaking illness?These are pist, for instance, in analyzing a patient's dreams important questions, and the modern dream hunter and judging whether these included more than a is equipped with new tools for exploring, but the normal number of fearful events.Although this (ire' m reports are still memories and we do riot yet large scale normative study is still in progress, the have methods of checking the speaker's veracity manuals offer some. guides foe judgment by citing from outside. the distribution of the categories of dream events Classifying Dreams for specific populations.For instance, an analysis of 1,182 dreams reported by young men and Some years ago, before the advent of electroni- cally tracked dreaming, sonic of these questions women suggested that about 2 out of 5 dreams were attacked very differentlywith methods a are fearful, often containing a sequence in which sociologist might use to classify the attitudes of the dreamer is pursued. A similar assay implied that for every dream of good fortune, a person people toward a sensitive issue such as birth con- may have seven dreams of misfortune.The trol.Here, hopefully, statistics might be used on ft large. Sample of qneslionnaires to filter out dreamer is more often the victim than beneficiary. Questionnaires filled out by students who con- the small lies and obfuscations of individuals and reveal the general attitudes of people in different tributed dreams indicated that they felt only about. ociner,onomic or regional groups. By amassing a quarter of their dreams were I leasant. a truly e:--ormons number of dream reports and ap- An analysis of 7,000 dreams shows up one nota- plying statistical analy s.-3, the Dream Research ble difference bet ween men and women. Men tend Instiii- of Miami, Fla., his been finding out the to dreiii about inen, in general, but women dream general kinds of dream content that typify cer- equally of men and women (Hall and Domhoff, tain groups of people: iminal college youngsters, 196:1). the physically ill, mentally ill, the aged, and people A recent study of the dreams of GO nurses sug- of particular ethnic groups. gests that women's physiological cycles may in- The institute, founded and directed by Dr. Cal- fluence their dreams. A tentative assay of dreams vin Hall, is probably the largest repository of before and during menstruat ion shows that ',rumen dream narratives in the world, its files containing may dream of Naiting for something, a bus, or some 30,000 dreams.Among these are 5,000 train, during the premenstrual period, whereas dreams collected from other countries and cul- dreams of destruction seem to occur during the tures, from _Australians, Peruvians, Nigerians, first days of the cycle. Mexicris, and many others. Many of these dreams The institute's new sleep laboratory is unusual have been broken down into components, classified, in the SelliT that it is located in a residential house and sulijected to stillistical procedmvs.Ifthis and has little of the laboratory aura.Ifere, while method can render the distinctive dream patterns attempting toobtainarepresent al ive(lream of a specific culture or distinguish between the sample from 27) healthy young unmarried men, the mentally ill and the healthy, a dream report may investigators hope to detect and correct the kinds become a diagno=t ic aid, Among other things, it of censorship and bias that have entered the dream may help a docto- foresee an impending mental reports collected oMsiiic the, laboratory. As this 1,re:olow7i, the onset of an acute cpisod,. empirical work continues on a Itrand scale, people tendencies.II may pro( idle itli iiIiil insight continue to iisk what dreams 1110:111.Are they into other cultures and iii the differ -n(-- in out- unspolten or unad mit teil by day ?A re they look hetIseen the scxes 195145). a safety valve ?Does unemot toneless dream- 100 0) ing indicate schizophrenia? Does one solve "prof). forcement and a positive component of niotivat ion. Terns" in dreams? Reactions of abhorrence hare also been p-oduced The task of interpreting dreams has grown no by stimulating another area in the hypothalamus, smaller now that we can clock them, collect more a center, roughly speaking, of punishment or of them, try to manipulate them. Today's accu- negative reinforcement.Motivation, as we think mulation of data has instigated a fart very ten- of it, may be based on the sensations of pleasure tative speculations, for dreams, their images, sen- or punishment attaching to certain acts or im- sations, emotions, are physically part of us, and the pulses. Pleasuro or pain can be evoked by directly blue rhinoceros that stalks the salon of our dream stimulating the brain, bui, like sleep and wakeful- reveals something of our nature. The images must ness, they rare induced by stimulation from the out- coins from somewhere. side world, by monotony, or sudden noises, that Speculations About the Neural Basis for Dreams send their impulses up the spinal cord. Similarly, they can be induced, likes voluntary sleep or wak- Someinvestigators have speculated that they ing, by impulses descending from the cortex, in- are made up of memories and are activated in the ternally generated. hippocampus, a neural formation that curls across It is quite plausible to think the center of the brain like two horseshoes joined of this motivational system as active during sleep, and if so, it might be the editor, the shaping power at the middle and curving outward toward the behind our dreams. During our wakeful hours, temples, ending in the amygdala. This region has especially in youth, we learn to suppress the be- beca thought to act as a clearit.ghouse for memory, a stage before memories are filed for storage. haviors and even thoughts for which we are usually Lesions of the hippocampus or amygdala will punished. By maturity, we hardly pay attention cause a loss of short-term memory. During the to this constant suppression of antisocial impulses. EEG phase that comes bonds to the ]ream period, In waking life, when the vigilance system is ac- animal studies have shown bursts of rhythmic active and dominant, our neural apparatus is ener- tivity from the hippocampustheta activity that getically holding down these punished itupulse3. spreads to a part of the brain that participates in The fact that a region of negative reinforcment awareness or attention. Perhaps this is the epi: ode lies close to the arousal sys'.-tm gives some encour- wecall a dream. However, asimple. kaleidoscope agement to this conjecture.During sleep, how- of images, memories, thoughts, would na explain ever, this very system that inhibits our pu aishcd the cold sweat of terror we suttee in a nightmare or impulses may be suppressed, itself by tile activity the pleasurable involvement we sometimes experi- of tho hypnogonic system. Aro repressed impulses ence.It would not explain why inconsistent now released in a manner resembling the release. images, the trivial intermixed with the momentous, 111^t comes with certain depressants like alcohol appear to have some meaning we cannot explain. or attest lieshis?;f this be the case, the punished One eery tentative explanation has been offered. impulses could now emerge and place their posi- In a word, it says that motivational centers within tive or negative weight upon the welter of images the brain are actuated dui ing dreaming and that that have been activated. ia this dreaming state of these centers may structure our dreams.This is sleep.It is unnacessary to belabor the point that the most punished impulses of the chill are those farr 'liar hypothesis.It was suggested by Freud behaviors and cu losities directed by basic drives. in evolving a theory about the latent content of If these are the ;:uppressed factors that st nicht.° ea cams. the otherwise incomprehensibk melange of dream T...u.ty,an anatomicalhypotl esisleas been material -the;, are indeed the elements of latent phrased by Dr. Raul Ilernandez-Peon, and while dream content, phrased somewhat differently by it is empLatically tentative, it suggests a neural Freud. background for the significance of Breams, indeed This is a complicated speculation and built upon perhaps explahling man's centuries of profound an enormous amount of anatomical and behavioral interest in dream symbols. A hyptiogenie system data.Although it may bo unfair to cite the hy- extending from Ca.+ front of the brain toward the pothesis so simply, it may indicate the 110V thresh- spinal cold overlap, with a portion of tho hypo- old over which dream interpretationthe question thalan,i s when,. Ft iT11111,!f11 evokes signs of pleas- of 'ilea n 1,0 tnol' ing.N-l'eophysiolog,ists ure-a e.mter, 0-- say, for positive rein- ate beginning to cutest that dreams may be 7 101 shaped by drives in an organization that brain their dreemers, but it opens up new avenues of research may soon begin to elucidate. A dream exploration that may not have scenic(relevant is a psychological phenomenon.It cannot be to dream interpretation 10 years ago.By using understood by physics.The act of dreaming, tools now being developed in neurophysiological however, is both a psychological and a physical and physiological research, we now begin to look process, determined by our structure and the learn- at the process by which dreams are formed.Here ing imposed upon our very cells. we may begin to find some of the complex but law- Drive Mechanisms in REM ful processes by which living experience accrues in the brain and is transmuted into that most Freud might be privately amused to see the private experience, the dream.The anatomy of implications of some recent research.The inten- dreaming, as we may learn from animals, may sive sleep studies of Dr. Charles Fisher at. Mount divulge some of the roots of fantasy, revealing Sinai Hospital in New York, suggest tha: the the way in which emotional learning encrusts strong sexual motivation i.aderlying dreams, as event and sensory experience.From young chil- Freud saw them, might be even stronger than dren in various stages of maturation we may hope Freud supposed.Preceding every REM period, to learn about the impact of environment in its from infancy onward, males have penile erections. larger ramifications.The development of new This does not mean they have overtly sexual analytic tools for reading brain wave rhythms and dreams; indeed, what would such a dream be for the necumalatio-i of data allowing us to localize Sexual activity, however, is part of en infant? their sources may give us a kind of Geiger counter oar survival equipment and something toward on the dreaming mind and its response to our wl.ich much learni g must be applied, step by manipulations from outside.Slowly we may step.The REM sleep, in which erections occur, learn how to disentangle the components of begins very earlyin premature babies, perhaps dreams. The findings and speculations mentioned in the womb. The function of REM activity, as here contribute to the disentangling.Ifthe Dement has suggested, may be that of a primitive dream memory is to provide an understanding of core activity, a rhythm in the rudimentary brain an individual personality, to be useful in therapy into which all later motivation and learning inter- or aid in diagnosis, we shoeld be able to differ- lo.les, a first practice in the bedy learning that entiate phsysiological ce ,,es, from cultural idia occurs with development.It is during this pre- synerasies, and from immediate event s--seeing the dominant phase of sleep that the infant first exer- pervasive style and shaping that is given to ;he ciFes his limbs, sucks, and smiles.This may rep- dream byanindividual.Since dreamsare rest,- t a first practice in the effectors of the great formed by physical processes, and since illness, Perhaps erections are drive forces for survival. mental or physical, presumably conies from alter- involved in the body-brain learning process of the ations within our cells, it does not seem impossible infer'.Theirexistencesuggests that sexual that dreams might provide diagnosticians of the drive mechanisms develop from the start and are future with .varning signals. The subject to influence by very early training. At present we have to rely upon intuitions and funct ion of such drive discharge in adult sleep is ediration sharpened by the mounting data.Sci- But un .plumed arid could be purely vestigial. ence cannot encompass all life at one gulp, and in adults, they are connected with dream content. life is the stuff dreams are built upon. Each The interesting dream is the exception, the. REM of us in a private universe weaves together a period that is not accompanied by erection or in myriad of experiences, important, and trivial which there is rapid detumescence.Data so far daily routine, learning, automatic responses of sugreest that these are dreams of intense anxiety, hunger breathing, and moments as transient often including body mutilation (Fisher et aL, as an eyelffink.Embedded in the central nervous 1965). system, shaped by leaniing, these are the tools of The fact that there may be a strong connection conscious behavior. By day it all seems purpose- between drives, dreams, and the covert symbolism ful and real, the actuality confirmed by others, but of dreams doe,-; not give us a direct handle for the the unsharable dream, for tle most part leaves no interpretation of specific dreams in relation to more. impression on memory than the shadow of 106 102 a leu'f falling over a stone.Since we tend to recall singled them out iior the game of interpretation. the nnusual, and for yet unexplained reasons do Today, at least, we may sample till whole gamut, someimes remember so-me figment from an im- perhaps seeing them as the processes of all mam- plain ible mirror-image world, we have throughout mal minds and not interpreting them as a har- histcy concentrated upon these f gleanings and birger of external world events.

109

103 Sleep brings no strength to me, No power renewed to brave... Emily Bronto

... it is a precarious commodity ... And a few a!;lits of hallow or broken or leaden or tormented or artificial sleep ... is carking evidense of its usual blessings. Walter de la Mare

Many cannot sleep for witches and fascinations... But the ordinary causes are heat and dryness, which must first be removal: a hot and dry brain never sleeps well: grief, fears, cares, expectations, anxieties ... and all violent perturbations of the mind must in some sort be qualified before we can hope for any good repose.lie that sleeps in the day time, or is in suspense, fear... or goest to bed upon a full stomach. may never ?tope for a quiet rest in the night. Robert Burton

Chapter X. Good Sleep and Poor Every night of sleep is not the same, as we all do n;,t, emerged as a byproch-st from an early test sAjectively know. One night may pass like a of Markovian chain analysis of the EEG sleep moment, from which we awaken simile, restored record.This is a mathematical technique for as- and vigorous; and yet the next night may seem fit- sessing the predictability of steps in a series.If ful. We may arise soggily, as if froma long a person were in stage 3 sleep, for instance, could wrestling match.One's mood on awakening may one predict the probability that lie would next be sunny one day and morbid the next.Ef Oh per- move into stage 2 rather than stage 4?The raw son varies somewhat, from night to night.Worry material for this analysis came from eight volun- may make sleep difficult, and sleep itself may seem teers, who spent four nights each in the laboratory. light.Depression may make one sluggish or On analysis the Marlcov chains for their records awaken one before dawn.Fever, alcohol, drugs, separated them into two homogeneous groups, each events, and a multitude of subtle unknowns play with its chain of BEG changes.One chain eh ir- into the texture of a night's sleep and its dreams. acterized the four subjects who slept soundly Everyone seems to have a subjective feeling for through she night.It was an orderly progz ass the difference between a good night's sleep and a from stages 1, 2, 3, 4, t, REM, 2, etc.The other poor one, but for most people life contains a group consisted of the restless four subjects who mixture. tended to awaken during sleep and often drifed Some people, on the other hand, complain Old upward from stage 2 sleep into stage 1 or awaken- they are usually poor sleepers.Others know they ing (Hammack et al., 19GO.:11though this study sleep easily.Sleep studies have shown that people was not undertaken in order to distinguish bet wee differ in the amount of time they spend dreaming, good and poor sleepers, it certainly tc,l I of a p .r- in their ability to do such things as press a switch ceptible d i ence between volunteers who Ca tile to during sleep, in iuemory of dreams, indeed, as the laboratory to be subjects in sleep experiment,. judged by the EEG record, some people have In our present tentative picture, of a normal shown very unusual slap patterns. night's sleep there are many varial ions, var;at EEG Differences that appear on other nion5anys than EEG.In Perhaps the first characterization of differences ctlinnAevery 1onn3n studs, have spoken between pulpit NV110 ly and thus »ho about the. range within 0 Hilljeci:: show the 704 '110 same responses.Not all subjects show exactly the Subjects become quite drowsy. During this study, same pattern on any measure, and some of these however, some subjects gave unusual reactions, variations may help to characterize sound and rest- loudly complaining, while other scarcely reacted. less sleep.The density of eye movements, perhaps The oversensitive snbjects were poor sleepers. reflecting a degree of brain stem excitation, varies These people also complained of discomfort in the in different dream periods and seems unusually laboratory bedrooms, although each participant high in some psychotic patients, unusually low in did sleep through an entire night while recordings others.These many factors may be the first hints were made of brain waves, body motions, heart to tell what are the differences between good sleep rate,skin resistance,rectal temperature, skin and poor sleep. potential, and finger pulse volume. The first investigation of the overall difference Physiological Differences between good and poor sleep was performed a year The data was averaged for cacti group, permit- ago with two matched groups of poor and good ting the investigator to compare the main trends, sleepers.D.Lawrence J. Monroe, working as a graduate student in the sleep laboratory of the and the groups differed sharply. Poor sleepers did sleep less. They took twice as long on the aver- University of Chicago, has shown that people who age to fall asleep, requiring 15 minutes, whereas complain about their sleep really differ from those the good sleepers took an average of 7 minutes. who admit they sleep well. These differences are Yet more interesting was the fact that the poor not merely imaginings. sleepers estimated that it took them 59 minutes to The volunteers for this study were attracted to the laboratory by a local adrertisement and were fall asleep while the good sleepers were more accu- rate in describing their own behavior.The poor chosen by answers to questionnaires.All were sleepers awakened almost twice as frequently dur- men between 20 and 40, and 16 were selected from ing the night and made many more movements of each group, chosen so that there were no subjects the body, shifts in position.The longest anybody with acute disorders that would disturb sleep, nor could have ve slept would have been 7 hours. The extreme insomniacs.The volunteers were matched so that each poor sleeper had an approximate good sleepers averaged 61/2 hours, the poor sleepers tours.Such differences are often mentioned counterpart among the good sleepers in age, education, and occupation. The groups did not differ in conversation about sleep and they are now documented in this initial study. notably in athletic inclinations.Each group contained students, laborers, professionals, physically Pronounced physiological differences are also active people, and inactive people.All of the par- associated with the restlessness and difficulty of the ticipants had to meet some minimum health stand- poor sleeper in falling asleep. Higher body tem- ards, and in obvious characteristics the outsider perature and faster pulse suggested that poor would have said that the two groups were very sleepers be physiologically closer to a waking state similar. than the good sleeper must. The pulse becomes Each subject filled cut the long health question- somewhat slower during sleep, ordinarily.Be- naire, the Cornell Medical index, and the Min- fore falling asleep the averf,,ze heart rate of the nesota 3fultiphasic Personality Index, a test cal- poor sleepers was 60.9 b.m s a minute.This culated to bring out dominant psychological traits dropped to 60.5 during sleep. The good sleepers and attitudes.In other respects, the laboratory showed a lower pulse raoc to start with. The aver- procedin a was straight forward and no more tax- age rate before sleep w:Is 60.7, and this had ing than innumerable other studies. Each person dropped to 56.0 during sleep.This is a consider- spent a night adjusting to sleeping in the labora- able difference between the two groups. tory with recording devices on his body. The next Body temperature differed similarly. although night. a variety of recordings were taken while be the numerical difference may seem minimal on first slept.Even at this stage in the procedure, the glance. Poor sleepers had an average temperature experimenters noticed that some subjects were nn- of 93 degrees before sleep, dropping to 97.0. The usually sensitive to the recording eleefrodes and good sleepers bad an average temperature of 07.7 thermi tors. before sleep, which dropped to an average cf 97.2. Ordinarily, lbprocess of being dressed h elec- A difference bet ween the two groups of only 0.1 trodes before retiring is relaxing, even soporific. of a degree may look insignificant, but the entire 111 105 sleep temperature range of the healthy adult is pectedly striking, the questionnaire pointed up only a degree and four-tenths.So, within this even more striking psychologicalifferences. range, a group difference of four-tenths of a degree Psychological Difference is sizable. Although the Cornell Medical Index is often A relationship between dream activity and body used as a quick assay of health, it is also used temperature has been postulated primarily because to gain information about psychosomatic com- the longest dream periods occur at the nadir of our plaints.It is a long questionnaire, and some of temperature cycle.This study again suggested its questions are addressed to objective complaints : some relationship bete een dreaming and temper- Do you need glasses to read?Others ask about ature. The poor sleepers spent less time in REM more diffusesymptoms,dizziness,headaches, Good dreaming than did the good sleepers. nausea.Included in the list are questions about sleepers, as a group, averaged about 21 percent of subjective adjustment.: "Do you feel alone and their sleeping time in the REM state.The poor sad at a party?Du people usually understand sleepers, as a group, averaged only 10.9 percent. you?" The so-called average and w,?,11 adjusted This enormous difference in proportion of dream- person will answer "Yes" to only about five or ing is not the whole story, however, because it is six of these questions. The good sleepers averaged based on group averages. The range within the about. 6.5 affirmative answers. On the other hand, poor sleeping group was very great, yet 12 out of the poor sleepers averaged about 23.9 affirmative 16 were dreaming considerably less than the good answers, suggesting that they suffer mon-, iy..ycho- sleepers. somatic ailnunts and experiences of maladjust- Whether or not chronic dream reduction had ment than the good sleepers.Discernible dif- something to do %vith the psychological di ffereno.ns ferences also appeared when the experimenters between the poor sleepers and the good sleeper-7 scored the Minnesota Muldphasic Personality In- is a moot question.That there were pronounced ventory; on this the poor sleepers seemed more differences is undeniable. In the light of some of hypochondriacal, introverted, anxious, and neu- the dream-deprivation studies of the past, itis rotic than did the good sleepers. interesting to note that a few of the poor sleepers Even this initial material strongly suggc.sts that had previously undergone psychiatric therapy. the differences in sleep quality are not merely dif- These people actually showed more dream time ferences in sleep.Poor sleepers seem distinctive than the others-23 percent.Others who had in pervasive ways.Questionnaire responses sug- never had therapy spent as little as 13 percent of gest they have more neurotic at.d psychosomatic their sleep in the dream state. This may have had tendencies.As a group they were more restless something to do with the fact that the. poor sleepers in sleep, fell asleep more slowly, indicated higher awakened about twice as often during the night. autonomic activity in heart rate, pulse volume, perhaps interrupting or preventing REM sleep and body temperature, and distributed the EEG and suggesting a higher statof arousal (hiring phases of sleep differently across the night. We sleep. do not know rbat makes a person become a good The EEG patterns of the hvo groups differed in or poor sleeper, nor the exact meaning of the the apportionment of sleep phases throughout the physiological concomitants. But these differences night.Beth groups spent some of the first half appear to be thoroughgoing, reflected in attitudes, of the night in stage 4, but they di!tributed it dif- sinsitivity to the laboratory Ind the equipment in ferently. The poor sleepers "used up" almost. all which they slept, not merely resiricted to night- their stage .1 during the first part of the night. time sleep. whereas the good sleepers had about 7:2 percent of their slow-wave sleep in the first halt and distrili- Sleep Quality and Constitution uteet the over the second half of the nigltt. The old family dnetor used to aver Wu [rood Town ,l the end of the night. Ike body te7uper- sleep was the source of %yell:Ewing and hale al- Mures of the poor sleepers here still declining. titude. an intuition tlr,has been repeated for wherea: the 7,01 dreprts were ,llowing n ri e in centuries' without offelnlin, cominon sells,.flit temperature about All holt. and :1 half before they tar rc i.in wuy of orderin,j, a pci-,-on to sleep woke up.The,re were FOMP of the inajr, ph.% sin- voluntary lrlrat iors individuals can log,iral differences, and Addle they were x- improve their sleep.We to not know to what

106 ip extent.This study raises tl e ugly suspicion that benefit from a drug or conditioning that improves there may be a predisposition to sleep well or his sleep. poorly, for the physiological differences reflected Differences between the good and poor sleeper in sleep may, in tura. be influencing behavior. may reflect their separation from each other along Could these physiological patterns hold clues to a continuum, a wide range of human sleep pat- physical complements of neuroses? Is there some- terns.They may be related to individual differ- thing about the poor sleeper that nukes him vul- ences spotted in many other studies. Some people, nerable, and overreact ive to his (nvironment? Or for instance, reacted more titan others to sleep is lack of rest the key to his other troubles? deprivation, or dream deprivation.People's drug Disturbed sleep can be part of a vicious circle responses differ, and ielinitesimal dose adjust- involving emotional and behavioral deterioration. ments lwd to be made for each individual before Sleep lee., in itself, induces a variety of curious LSD in microdosages would leave their mark on symptoms, and in extreme, is attended by almost. dreaming.The ration of al:thol that put one psychotic symptoms.It is associated with an cat to sleep left another curious and lively.In- alteration of the body's energy metabojism. A dividual differences have been expressed in diverse relatively short period of sleep loss is accompanied ways.Volunteers in sleep studies have differed by the production of an indole associated with in their ability to press switches during sleep, fol- stress, a chemical of tile LSD or serotonin low instructions, in their amenability to hypnotic Commonly, the physician sees sleep disturbances suggestion during sleep, and in their ability to during a prelude to mental breakdown, (luring de- recall (Yearns.Within dream-recall studies we pression, before acute psychotic episodes.The may be seeing two extremes of a continuum, for loss of a single portion of the EEG distribution one person appears to sleep so deeply that his has anaftermath.After IU[ deprivation, dream has vanished by the time he awakens, while whether or not individuals have shown behavioral another claims he does not dream, apparently con- effects, fly wake 1.1p for lost REM time.Simi- fusing dream Ivith waking, and dreaming, in such larly, wileu deprived only of stage 4, people make a light stage of sleep that he can hear the air con- up that stage of sleep by spending a compensatory ditioner and othor rr iscs in the room. Many of proportion of sleep in stage 4.Perhaps scale ,7iifereitL'(., may be constitutional, the coun- regular quota and distrilmt ion of the EEG phase t(te.irts of pervasive genetic endowments that is necessary to each individual.Lt severely de- show up in personality and behavior as well as in body build, Moot; type, hair color, and on other presid natie.its and 1 'hoti(s during acute episok s, tl are oilalous patterns within the physiological measures. The influence of inherited dream periodI-AM' transitions between waking factors is enormously difficult to determine with and dreaming, unusually high percentages of human beings, and consequently has not been ex- dreaming sleep (Hawkins, 1965; Hartman et al., plored intensively in relation to sleep patterns. 1964).The numerous studies of mentally ill per- The d if iculty of ascertaining constitutional factors sons, of epileptics,narcoleptics., enuretics and may explain why they are so often omitted from others all suggest a link between anomalous sleep behavioral considerations in human studies. patterns and dist-014,ml i,-.havior.This does not One of the trends shown by poor sleepers, how- say whether the mild disturbance, the neurotic ever, may provide a means of exploring predis- sips of the poor sleeper Nvould be alleviated by positions without going back into family traits and impossible genetic skeins.The poor sleeper better sleep.What we hare seen in these re- seems to be in a somewhat heightened physio- searches is that sleep is an orderly cycle involving logical state, before and during sleep.Is this bodily changes and altered states cionsnes.s, roughly analogous to a motor that races when it a unity of psychological and physiological trans- should be idling?Is the poor sleeper tuned to formations thatis not separable from waking higher aronsal, hyperreactivity ?Is his metabolic health and behavior. The process resembles the and neural baseline just slightly different Clan turning of a wheel on Nthiell it is difliculf in It!'sign that of the good sleeper?Could the higher ht art a point wInwe the motion began, but Nvlikh can he rate, temperature, and Cie numerous a walumings braked.Therapy may be applicable at several mean that he is overproducing neurocluanioals that levels, and it is possible that the poor sleeper Might stimulate the arousal system, or that he under-

113 107 produces chemicals that stimulate the hypnogenie development of behavior, and insight into the inhibiting system?There are many alternative physiological differences that may ren ler one per- metabolic and neural adjustments that might ex- son vulnerable to an environment, to a family, plain this physiologicaldifference,. A braking where others no not marred. Such explorations chemical that prevents overactivity in certain cells, may help to solve some of the perplexing riddles may be deficient.Although this is climbing into that confront investigators of many abnormal be- the realm of pure speculation, we are now able to haviorsamong them the neurotic or the juvenile ask questions that could not have been asked sen- delinquent whose behavior differs greatly from sibly ever. a few years ago. Indeed, recent progress that of his sihlings. has been so rapid that the answers may not be far Summary distant. luring the last decade, scientists of many dis- We have mapped hypnogenie and arousal path- ciplines, using different instruments and inspired ways within the brain, triggered by chemicals that by different interests, have converged onto the may also turn out to medirde the influences of study of sleep only to discover that they were ex- hormones, stress products, and other substances. ploring related events, fundamental processes in- The hypnogenic and arousal areas are connected volved in mood, behavior, memory, health and ill- with sulyortical regions regulating autonomic ness, sanity and madness.The contagious ex- functions such as heart rate and temperature, in- citement generated by these researches has not stinctive drive responses, pleasure, or pain.The stemmed from the many isolated and useful dis- varied basic studies from which these findings coveries so much as from their convergence to- emanate, may begin to explain the neural and ward central mechanisms in the nervous system. chemical origins of the patterns of the poor The sleeping brains, of monkeys and chimpanzees sleeper.At the same time that they give a pre- have clarified the nature of epilepsy, and the sleep- dictive and controllable understandihg, of the high ing rabbit pointed to links between mood and heart rate, arousability, of the poor sleeper, they fertility.Physiological transformations in people also may be explaining why he suffers psychoso- and sleeping animals have suggested the instinc- matic complaints and neurosis. tual basis of dreams. Like the spokes of a wheel By :refining precisely some of the physiological leading to the hub, seemingly unrelated studies of characteristics and psynological concomitants of muscles, finger pulse volume, attention, drugs, good and poor sleep we may provide the doctor dream and sleep loss, have shown links and have with a new diagnostic, inventory.Sleep, and re- illuminated some of our puzzling sleep disorders sistance to sleep loss, as others have suggested, may and symptoms of mental illness.The confluence indicate how well n person can perform under of these fragments has generated theories ttbout stress. But by pursuing these differences between the way the nervous system functions during sleep good and poor sleepers to their neural origins, we and waking, and this may explain the prolifera- may begin to answer questions about individual tion of sleep studies, significant even in the last differences that have long eluded our grasp.Are year.Communication among the worhbscattered many neuroses the behavioral concomitants of s. ientists of sleep may explain the astonishing rate hyperreaelivity? What causes a person to be of dis-overy. oversensitive to his environment, to pain, and to Less than 10 years ago, as scientists began mov- situations that leave others unscathed?Are there ing neross the borders of what we used to call also people at the other end of the scale, who nnder- unconsciousness, they began demonstrating that react, on whom the environment and its social sleep was not an unconscious suspension from life, teachings leave too little impression-sociopaths devoid of complex behavior and only tangentially and psychopaths?If these tendencies are rooted related to the quality of our days.Instead, they in mechanisms whose signs we see in sleep, could confronted a very active inn in which, in one stage we detect them in early childhood?Although the of sleep, re=enilded waking to an amazing degree. links between predispositions in personality and They confronted questions about attention a: nett pattern, of sleep nary 014 ha conic, tuned at this aszo21)/101ellee runt rt'llXittion. They time, the clues from aserved sleep patterns, are with sleepers and rcceived answering signals. clues for internal exploration. We may at past be One important fulcrum was the discovery that gaining a key to pervasive patterns underlying the all sleep was punctuated by intervals of rapid 108 1 14 EEG rhythms and eye movements, and vivid stem and related regions during the dream state, dreaming., a state not unique to man, but found other scientists have concentrated atter tion upon in mammals down tothe primitive opossum. such distant brain systems as the hippoeampus. Today, the evidence suggests that the visual im- Single electric stimulations to this area and other agery of dreams is not man's prize but eNists in brain regions will produce the familiar brain the monkey and perhaps all seeing animals. Both waves of activated, or paradoxical sleep.The men and animals show a need to dream, for when hippocanmus has been associated with memory depriNed of the REM (-imam state by loss of sleep, and einotl=m, has been shown to be related to th3 by drugs, by anxiety, or deliberate, awakenings, the cortex and to subcortical areas, to activity in the normal individual quickly compensates., making autonomic nervous system and body muscle sys- up the loss in subsequent sleep.Since many tems.These links may help us to learn how the mental illnesses are accompanied by sleep disor- contents of the inner dream experience are pro- ders, by broken sleep, anomalous dream periods, duced and how they are related to the physiological people inevitably wondered whether and how emo- events seen during the REM dream state.They tional disorders related to abnormalities of the Wray also suggest some links between the state of REM dreaming mechanism, perhaps coming from anxiety in which an individual may be less than too little REM dreaming. usually sensitive to his surroundings and the brain Some nettrophysiologists were finding that the mechanisms producing REM dreaming.In both dream state could be brought on by directly stim- anxiety and dreaming a portion of the brain may ulating a portion of die brain stein in animals. be operating in almost a closed circuit manner. Tt was abolished if a spot were destroyed within Theory is always bound to be partly wrong, but this primitive brain area.Although the regula- it has been the evolution of theories that encour- tion of sleep and dreaming seemed to be more ages experiment, motivating discoveries that would elaborately governed and diffused in primates and otherwise be lucre fragments, or might never be man than lower animals, this important locus in clone.So in sleep ro,search, theories have inspired the brain stein led to conjectures with many im- the accumulation of data which are now beginning plications for the understanding, of psychoses and to fit together 'old explain some of the most baf- the function of dreams. It is a very old region of fling of sleep disorders.Sleepwalking is an exam- the brain, one of the first, to form in the develop- ple.Muscle IlDeeldity during sleep and other ing embryo, giving evidences of its rhythms findings about the dream =tote did not jibe with before there are signs of the cortical rhythms of the common idea that sleepwalking occurred in the sleep.Perhaps this might explain why infant REM dream state.Bedwetting and somnambu- animals and infant humans were found to have lism, indeed, both recurred during other stages of more of this dream-state rhythm which declined sleep.Inferences from many studies of the brains with sge as the cortex matured.Perhaps, indeed, of sleeping animals and people may explain how the dccline of the dream state might Iroome a meas- the somnambulist shambles around furniture, eyes ure of normal brain development in very young open, yet giving no expression of seeing.During infants. slow-wave sleep, sensory impulses flood Lit° the Further studies of the dronni she sug:;e-1ed brain, but the integrative. regions that create per- that it ni ght be triggered biocliemically and that ception and awareness function in an altered, loss of REM dreaming enhanced tie drive ori- delayed manner. ented behaviors of animals.This in tm n, sug- A new picture of narcolepsy has emerged. The gested that abiological function of dreaming attack is one of normal sleep in an abrupt drop might be the development of drive mechanisms from waking' into the ]EM dream state, with a within the embryo and infant.A later fo;,c! ion sudden loss of muscle, tone.A. seizure. locus in the of the (grant state may be the disc' !Ar:w of e\cite alnygdal;i lweli postulated and also dream loss. ment in the brain's "drive renters" ;ireompa nied by The amphetamines narcoleptics take in order to a great Array of p s-ychologica I rele,o-e.:. stay awake hi VI' been foam' to have a REM-rodw.- A lao,,t salieic property of Ow brain. one deal ing effect.Al, hough the exact brain mechanism makes it formidable to study, is its emulates int er his not yet beau decip'ared, new diagnostic proce- relatedness.While many experimenters have eon - dures and Therapy have been de eloped out of the cent rated upon the relationships bet ween the brain studies so far. 1 15 109 The practical consequence of sleep research. ex- ate stress, hunger, sleep loss, pain, dream depriva- tend, into every realm of living and certainly into tion?Could we learn from this sleep record about our use of drugs.Alcohol, barbiturates, and his ability to remember dreams, to perform tasks many tranquilizers depress RE.M. dreaming, for during sleep, his response to certain drugs? Could instance, although they differ in their impact. The we predict from these physiological indices his effect upon neural mechanisms of dreaming may propensity toward psychosomatic ailments, and also explain I..- i,overs, and drug psychoses.Bar- the intimations of his personality that he will biturates do more than reduce, REM dream time, leave on psychological questionnaires?Does the they interfere with integrative processes in the heightened physiological state of a poor sleeper brain, which in turn, may be participating in main- indicate a high setting within the brain's system of taining body functions.It has been thought that arousal -- leading him to overreact to the environ- some psychotics, or narcoleptics, or other individ- ment?If so, could we detect incipient neurosis uals suffering from dream loss might benefit from early in life?As the findings from dixerse sleep increased dreaming. Cm rent explor-dions of LSD studies are juxt aposed, they begin to suggest inter- and gamma .hydroxybutyrate suggest that a drug nal links, and raise innumerable questions of mon- therapy to increase dreaming may be possible.As umental importance to medicine and psychiatry. a result of sleep studies our use of tranquilizers, These questions are beginning to be clarified by sedatives, and antidepressants, 'nay be -2'arless studies that may seem remote, but the scientist haphazard, for we are beginning to determine how observing human behavior is like an astronomer they act upon the L rain, why individuals react with an optical telescope, recording what can be differently to the same drag, or to a particular seen with the eye, while unseen and invisible radia- concentration. tions from that same, place must be interpreted We are just oeginning to explore the chemistry through radio antennas. of sleep, to see how natural body substances such as New instruments and techniques of analyzing sex hormones influence sleep.Here may be the data have become increasingly important in brain rt,ots of many ahnoftnalit ies, for sligh increases in study, where most of our questions lead.Using steroid hormones that produce sleep, can mean tiny electrodes, deeply implanted in the. brains of anesthesia, or convulsion.Anatomical mapping animals, researchers have begun to read what is of the sleep circuit and arousal centers in the brain happening in the brain during the di tTerent phases has employed two ueurocliemicals which may be of sleep. the basic transmitters, the crucial chemicals t ha. The discharge patterns of single brain cells, as mediate sit ep and arousal.Insufficient supply of well as groups of cells, are yielding clues about the hyTtiogenic t ransmit ter may curse the insomnia neural organization (luring dreaming. about the of the elderly, who awaken too early.Oversupply nature of hallucination, and seizure.The brain's of an arousal mediator may play n role in the responses to signals has enabled us to track the inability to fail asleep.1Vith in the metabolism of neural mechanisms by which a mother learns to the sleeping brain we may expect to find the clues awaken to her child's whimper, yet sleep through to mlny perva,ivo. ;infl perhaps also traffic.From studies of brain eeTonses, averaged pervasive personal tendencies.1)o sine people and analyzed by computer, we have inferred a fun- tend to inhibit ion and others to arousal ?Under dament al distinction het vcen dreaming and other the horrendous conditions of battle that agitate deep sleep.During REM dreaming, the sensory most people, some soldier; are known to have. impulses are screened out, to an extent that resem- fallen asleep in the trenches.There. are malty bles the censorship of waking in moments of at ten- instamesinwhichasituationfraughtwith t ion.Thus, t he dream state appears to be a period emotion has caused a soporific reaction within one Of intense inward concentration, in which brain person, a restless reaction in another. activity bears some resemblances to waking. Very pen ((live individual differences have been Encephalographers cannot distinguish, by eye, noted throughout sleet» relies, expressed in the many shifts. of attention and subtle transfor- behavior and attitude and in physiological pat- mations that occur throe Font a1-;eking and sleep, teras.Are these. related ?Are we on the way for massive information is hidden in the EEG. toward looking at a person's polygraph to,.ord Jkny new mat hem it ical I e(7.1m Hues for analyzing during sleep and predicting lu.w well he will (oler- the EEG data have been developed to eke out this 110 116 information, to determine whether a few seconds Psychologists discover rapid eye movements dur- of brain waves resemble each other in frequency Mg dreaming, and neurophysiologists trace excite- distribution or power. The computer has become ment within a brain stem area through linked an essential instrument to perform the manipula- regions of the visual system.Curious sleep and tions, or calculations of most sophisticated brain dream patterns are observed in some psychotics, research, and indeed for any refined reading of the and untoward reactions to certain sedatives, and EEG. This is, of course, at the very heart of the brain researches begin to explain that schizophre- matter. The EEG is a staple instnthient for gaug- nia shows an impact upon attention mechanisms, ing the behavior of the mind, and the further re- upon which tranquilizers and barbiturates act finement of EEG analyses may make it a diag- differently. nostic tool with which we may be able to discrim- As the EEG analyses become ever more refined inate between the patterns of the normal person, and activities deep within the brain are further cor- the neurotic and the schizophrenic.Indeed, by related with the ripples they create at the surface, tracing the patterns of attention and other states the n;ghtlong record of sleep may become one of of consciousness we may be able to distinguish be- our most useful diagnostic tools.It may tell us t ween the many kinds of psychoses we now call about the integrity of an infant's nervous system schizophrenia.Mental disorders, as they are re- long before there is any behavior to test.It may flected in sleep patterns, may be tracked to their warn us of incipient mental breakdown, allow us to brain origins more precisely as these new methods prevent fatal coronaries in sleep, reveal whether come to wider use. drugs are beneficial or harmful. L may discrimi- Neural changes and brain processes that are not nate between people who can resist stress, and those perceptible on the EEG, have been tracked by a who may be vulnerable, predict lifelong tendencies, new tool that measures changes in the electrical proclivities for psychosomatic ailment and neu- resistance of ileum] tissue.Recent studies illum- rosis.It should not be discouraging that these are inating the action of the sleeping brain have shown phrased as future possibilities rather than present that the single nerve cell transmits messages in a certainties, for this area of study has scarcely had rhythmic code composed of discharges and spaces. time to begin. Knowledge of our sleep patterns, Impedance measurements of resistance changes our daily temperature rhythms, the impact of age which may occur in nonneural glial cells may tell and habit upon our response to sleep loss, our how the er.oitability of the nerve cell is modulated transitions from waking to sleep and from sleep by surrounding influences.Thus we may begin to to wakefulness should become, useful to each in- find out how patterns of electric waves occur in dividual as it is useful to know that one is sick when various parts of the brain, in seizure activity like one has fever, or should not drive after drinking. epilepsy, and the widespread change; wc know as One of the very great contributions of sleep re- sleep. search could he the enrichment of !Inman :onscions- The equipment, the mathematical analyses, and ness and enlargement of human capacities. The the intricate techniques of these basic investiga- EEG has been used a: an educational instrument tions aro expensive. The conclusions may seem in- to teach people to recognize and control a state of comprehensible on the surface, and distant from consciousness they had not been aware of. Volun- immediate problems of mental health. No serious teers in the laboratoty have learned to decrease scientist, probing a biological mechanism for its blood ressure. The yogi's extraordinary bodily internal laws, would want. to promise particular controls and voluntary immunity to pain come applications, yet the unforeseen yield of these un- from roundabout disciplines. We, too, may begin approachable basic researches aro what we count to acquire such disciplines by more systematic upon in the long run.If sleep research has produced rich and practical insights into the avorking means.If emotional states and autonomic func- of the mind, its productivity must be credited to a tions can be modified by the individual, psycho- symbiosis and communication among the. partici- therapy anthe treatment of psychosomatic ill- pants. Clinicians report a bizarre bra in wave pat- ness' may substitute traiuing for drugs.As we tern in the brain of an epileptic patient in sleep, tetra the determinants of sleep we may also ac- and studies of the chimpanzee indicate that this quire the knack of some unusual penile, who in- is a normal pattern althoul., never observed before, duce sleep by deciding, to sleep and who seem to

_V/ 111 awaken themselves by mental clocks, perhaps in from the brain, perhaps making its first appearance a phase of sleep near arousal. in the young in the dream state. As research be- Sleep researches are beginning to offer tools of gins to reveal the correlates of thesetates it may self-knowledge.People may begin to sense their be offering us methods of becoming acquainted cycles of alertness and drowsiness, and take ad- with the feel of our own minds, an important step vai'tage of the natural timing of their bodies, and in using them. ithnds.Attention, that subtle state whose neural components have begun to be pursued, may also hard ly foreseen 10 years ago, the study of sleep become a faculty that we deliberately enhance in has extended its benefits into medicine, pharma- the 3 otvg, for the control of attention is often a cology, psychiatry, into the scheduling of work and deeidiug factor in the productivity of a life. The rest, and into the education of the individual ac- concentration that might multiply and extend the quaintirg him with himself and the uses of his abilities of more people, also shows its rhythms remarkable brain.

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