Mental health articles

When sleep takes place, however, the relation of sleep to hypnosis ceases. This hypnagogic state occurs in all individuals and is markedly protracted in insomnia, particularly in those subjects who complain of absolute loss of sleep. In this hypnagogic state, many peculiar psychic and motor phenomena may appear, and there is also obtained, as in real hypnosis, a condition of increased suggestibility, so that it possesses a certain therapeutic value. We will first consider a condition of muscular activity which is peculiar to the hypnagogic state. It is well known that even on being suddenly awakened from a deep sleep, full  consciousness is  not immediately regained. Complete consciousness is reached only after passing through this intermediary hypnagogic state. In this state, there is sometimes an extreme difficulty in opening the eyelids, at other times a complete inability to move the limbs. After a time, however, and by continued effort of the will, the eyes can be opened or the limbs moved. When this point has been attained, consciousness has become completely restored and the hypnagogic state has entirely disappeared. Now this transitory paralysis of the limbs and eyes occurs frequently in normal individuals, but is only momentary. 

Sometimes, however,  the phenomenon either occurs frequently or is greatly prolonged.  Under  both  these condi tions we are dealing with what I have called nocturnal paralysis.1 When this paralysis is frequent or unduly prolonged, it becomes a genuine functional nervous disorder. In one of my cases, this inability to move the limbs lasted for fifteen minutes. A brief report of a case which came under personal observation will illustrate the matter more clearly than any description. It refers to a patient in whom these distressing attacks of nocturnal paralysis had persisted for a number of years. After a sound sleep he would awaken suddenly, know where he was and who he was, but could not recall his name. Therefore, consciousness was not completely clear, a prominent characteristic of the hypnagogic state. In the attack the eyes were closed and the limbs rigid. He was unable to open the eyes, to move the limbs, or to cry out. The duration of the individual attacks averaged about three minutes and they occurred about once a week. In another subject the condition of nocturnal paralysis was vividly described as “I feel like a doll whose eyes can be opened but who cannot move the limbs.” The condition in all these cases is only a dis sociation of consciousness reacting most strongly on the motor mechanism. It bears no relation to epilepsy, as one writer would lead us to believe. Neither does sudden awakening from sound sleep bear any relation to the disorder, for in some personal experiments on sleeping animals which were suddenly awakened by a loud noise, not even a temporary muscular rigidity took place. Other peculiar phenomena occur in this hypnagogic state. Hallucinations of hearing may take place, as in the case of the patient cited above, who heard a voice repeating, “Lower the jib.” Sometimes there are heard loud sounds like a gong or a piece of falling metal, and the half-sleeping subject is suddenly awakened by these sense deceptions. Occasionally there are shock-like startings of the body or a sensation as if falling.

A condition called catalepsy may also arise, in which the limbs can be molded like a piece of lead pipe and kept in a strained position for some time, without any apparent sense of fatigue. Horrible dreams may take place with a sense of great fear, as in the night terrors of children. Occasionally, the hallucinations are those of touch, either a light touch or a sensation as if we were gripped in a vise. When this latter occurs, there is usually associated a terrifying dream with great fear and a sense of impending suffocation or death. This is the so-called nightmare. In the case of a woman, there arose a sense of an awful calamity about to overtake the patient; a deformed man would seem to spring on her, and she would think, “It has overtaken me, this is the end of all.” Then she would cry out and the scream would awaken her. In another case the patient felt as if she were grasping something, a pencil or a person’s wrist; sometimes the sensation would be as if the fingers and toes were swelling to the bursting point. These nightmares have also been interpreted as nocturnal states of anxiety, based upon certain repressed sexual conflicts. The phenomena of nightmare, as shown by Ernest Jones, explain the mediaeval theory of a fiend who sits upon one’s bosom and hinders respiration. These hypnagogic hallucinations have been utilized with great imaginative effectiveness by Guy de Maupassant in his description of a nightmare. In his novelette “Le Horla” he describes the development of an incipient mental disease. The sufferer in question was a victim of insomnia and believed that he was pursued and haunted by an imaginary being. Then in terribly laconic sentences, the author gives us a most vivid description of the following condition, which is really a hypnagogic hal lucination, a kind of a night terror. “Then I lay down and waited for sleep as one waits an execution…. My heart beat and my legs trembled; my entire body started in the warmth of the sheets, up to the moment when I suddenly fell asleep, as one falls into an abyss of stagnant water when dreaming…. I slept—a long time—two or three hours—then a dream —no, a nightmare took hold of me. I felt that I was lying down and that I was asleep—I felt it and saw it—and I also had the feeling that some one approached me, looked at me, touched me, mounted on my bed, knelt on my chest, took my neck between his hands and squeezed—with all his force to strangle me. I struggled, bound by this atrocious power…. I tried to cry out—but was unable to;—I tried to move— I was unable to; I tried with fearful efforts, panting for breath, to turn, to throw off this Being who crushed and stifled me—I was unable to. And suddenly I awoke, covered with perspiration. I lit a candle. I was alone.” There are a number of conditions which outwardly resemble sleep, yet are distinct from it. The so-called African sleeping-sickness, which occurs with the greatest frequency in the region around the Congo River, is a condition of gradually increasing stupor, which terminates in death. It is caused by a microorganism be longing to the Protozoön group, which is found in the blood and central nervous system, and is transmitted by a certain African fly. A morbid disposition to sleep, coming on in sudden attacks, and characterized either by mere  drowsiness  or  complete unconsciousness, is sometimes seen in hysteria and particularly in epilepsy. This condition is called narcolepsy and the attacks are designated as narcoleptic attacks. A form of stupor, outwardly resembling sleep, is seen in some forms of mental disease, particularly adolescent insanity. The sleep of anesthetics, such as ether or chloroform, is due to the direct chemical action of volatile drugs upon the brain. Here the analogy with sleep ends, because the depth of unconsciousness produced by these anesthetics is much greater than in normal sleep, as shown by the complete insensibility to pain. It must be admitted, however, that before ether or chloroform anesthesia becomes complete, there is always a preceding semi-drowsy state, the same as occurs just before normal sleep. Hypnosis only outwardly resembles normal sleep. The relation of sleep to hypnosis will be discussed in the chapter relating to this latter condition. Sleep-walking or somnambulism, in which many complicated and seemingly natural acts are executed with a loss of memory for these acts, occurs not only in the disease hysteria, but also in normal individuals. Somnambulism, however, is not sleep, but a special mental state arising out of sleep through a definite mechanism. It may assume various types, either the ordinary form of sleep-walking or may develop to the high degree of actual changes in the personality. In both instances, it is probably a form of mental dissociation. The amnesia is only an apparent one, as the memory may be recovered by appropriate methods. In one case of somnambulism, it was possible to restore the memory for all the complex acts of the period, although this period was of an hour’s duration.

Tags: psychology, sleep, theory