Mental health articles

Sometimes insomnia may be due to the development of a fixed idea that sleep is impossible. One patient said, “I cannot get it out of my skull that I am not going to sleep.” Janet had studied in great detail a case in which the sleeplessness was due to a fixed idea.1 In this case, the patient developed a severe attack of typhoid fever four months after the death of her child. During convalescence from this illness, she suffered from an almost continual visual hallucination of her dead child, particularly at night. After this sleeplessness developed, and when she first came under Janet’s observation, the patient claimed that she had not slept a wink for two years. This almost complete loss of sleep was verified by careful observation. During the day she complained of fatigue, and the facial expression was that of one half asleep. Drugs failed to induce sleep; hypnosis produced only light states of short duration, in which the patient would awaken suddenly, with an expression of terror. At night also, she would go into a half-drowsy condition and awaken suddenly, much terrified, saying that she had had a bad dream, but which was only vaguely remembered on awakening. When questioned during her somnolent state, it developed that the so-called dream consisted of an hallucination of her dead child.

The insomnia was due to the fact that the hallucination developed immediately after the somnolent condition took place; the patient would then become  terrified and waken. Here was clearly a case of insomnia due to a subconscious fixed idea. The depth of sleep is variable. We have the lighter subwaking  states  in which consciousness is almost perfectly preserved, the deeper somnolent conditions in which dreams occur, and finally the deepest grades of sleep, in which consciousness is reduced to such a low threshold that it may be considered as being almost entirely obliterated. In these somnolent states the sense of the lapse of time is only partially obliterated, in deep sleep completely so; we may have slept for hours but on awakening we have the illusion that it has been only a few minutes. Sleep is most profound in the early part of the night or within the first half-hour after falling asleep, and it becomes more shallow during the early morning hours.

In some experiments with the capillary electrometer on sleeping subjects, it was found that the greatest depth of sleep was reached in about an hour and that this period corresponded with the greatest degree of muscular relaxation. It is of interest to note that it is just during these early morning hours when sleep is lightest, that dreams are most apt to occur. The depth of sleep is measured either by the height from which a metallic ball must be dropped to awaken the sleeper or by the intensity of an electric cur rent from an induction coil.

However, if there is an element of expectation, a very slight noise will awaken the sleeper, as in the case of a sleeping mother being awakened by a slight movement of her child. This subwaking state to which we have several times alluded, where the individual hovers between sleep and waking, is of great practical and scientific interest. When it occurs spontaneously, it is technically known as the hypnagogic state; when it is experimentally produced by listening to a monotonous sound stimulus, while the individual is in a state of muscular relaxation with limitation of voluntary movements, it is called the hypnoidal condition (Sidis), or the state of induced or experimental distraction (Coriat). The spontaneous hypnagogic state may be only momentary in duration or it may last for fifteen minutes or more. It occurs just as one is falling asleep or as one is awakening from slumber. It appears that we never go to sleep or waken suddenly. There always intervenes this hypnagogic state between sleep on one side and awakening on the other, a state bordering on hypnosis, really a natural hypnotic state, particularly when it occurs just before the individual falls asleep.

Tags: sleep, theory