Sleep

Sleep (0. Eng. sloepan; Ger. schlafen; cf. Lat. labi, to glide, and "slip"), a normal condition of the body, occurring periodically, in which there is a greater or less degree of unconsciousness due to inactivity of the nervous system and more especially of the brain and spinal cord. It may be regarded as the condition of rest of the nervous system during which there is a renewal of the energy that has been expended in the hours of wakefulness; for in the nervous system the general law holds good that periods of physiological rest must alternate with periods of physiological activity, and, as the nervous system is the dominating mechanism in the body, when it reposes all the other systems enjoy the same condition to a greater or less extent. Rest alternates with work in all vital phenomena. After a muscle has contracted frequently at short intervals, a period of relaxation is necessary for the removal of waste products and the restitution of energy; the pulsating heart, apparently working without intermission, is in reality not doing so, as there are short intervals of relaxation between individual beats in which there is no expenditure of energy; the cells in a secreting gland do not always elaborate, but have periods when the protoplasm is comparatively at rest. Nervous action also involves physico-chemical changes of matter and the expenditure of energy. This is true even of the activity of the brain associated with sensation, perception, emotion, volition and other psychical phenomena, and therefore the higher nervous centres require rest, during which they are protected from the stream of impressions flowing in from the sense-organs, and in which waste matters are removed and the cerebral material is recuperated for another time of wakeful activity. (See also Hypnotism, and the physiological sections of the articles Brain, and Muscle And Nerve.) The coincidence of the time of sleep with the occurrence of the great terrestrial phenomena that cause night is more apparent than real. The oscillations of vital activity are not correlated to the terrestrial revolutions as effect and cause, but the occurrence of sleep, in the majority of cases, on the advent of night is largely the result of habit. Whilst the darkness and stillness of night are favourable to sleep, the state of physiological repose is determined more by the condition of the body itself. Fatigue will normally cause sleep at any time of the twenty-four hours. Thus many of the lower animals habitually sleep during the day and prowl in search of food in the night; some hibernate during the winter season, passing into long periods of sleep during both day and night; and men whose avocations require them to work during the night find that they can maintain health and activity by sleeping the requisite time during the day.

The approach of sleep is usually marked by a desire for sleep, or sleepiness, embracing an obscure and complicated group of sensations, resembling such bodily states of feeling as hunger, thirst, the necessity of breathing, &c. All of these bodily states, although on the whole ill-defined, are referred with some precision to special organs. Thus hunger, although due to a general bodily want, is referred to the stomach, thirst to the fauces, and breathing to the chest; and in like manner the desire for sleep is referred chiefly to the region of the head and neck. There is a sensation of weight in the upper eyelids, intermittent spasm of the sub-hyoid muscles causing yawning, and drooping of the head. Along with these signs there is obscuration of the intelligence, depression both of general sensibility and of the special senses, and relaxation of the muscular system. The halfclosed eyelids tend more and more to close; the inspirations become slower and deeper; the muscles supporting the lower jaw become relaxed, so that the mouth opens; the muscles of the back of the neck that tend to support the head also relax and the chin droops on the breast; and the limbs relax and tend to fall into a line with the body. At the same time the hesitating utterances of the sleepy man indicate vagueness of thought, and external objects gradually cease to make an impression on the senses. These are the chief phenomena of the advent of sleep. After it has supervened there are many gradations in its depth and character. In some cases the sleep may be so light that the individual is partially conscious of external impressions and of the disordered trains of thought and feeling that pass through his mind, constituting dreams, and these may be more or less vivid, according to the degree of consciousness remaining. On th&other hand, the sleep may be so profound as to abolish all psychical phenomena: there are no dreams, and when the sleeper awakes the time passed in this unconscious state is a blank. The first period of sleep is the most profound. After a variable period, usually from five to six hours of deep sleep, the faculties awaken, not simultaneously but often fitfully, so that there are transient periods of consciousness. This is the time of dreaming. As the period of waking approaches the sensibility becomes more acute, so that external impressions are faintly perceived. These impressions may influence and mould the flow of images in the mind of the sleeper, frequently altering the nature of his dreams or making them more vivid. The moment of waking is usually not instantaneous, but is preceded by an intermediate state of partial consciousness, and a strange play of the mental faculties that has more of the character of an "intellectual mirage" than of consecutive thought.

The intensity of sleep has been measured by Kohlschi tter by the intensity of the sound necessary to awaken the sleeper. This intensity increases rapidly during the first hour, then decreases, sometimes rapidly, sometimes slowly, during the next two or three hours, and then very slowly until the time of waking. This statement agrees generally with experience. As a rule the deeper the sleep the longer it lasts.

Various physiological changes have been observed during sleep, but much remains to be done in this direction. The pulse becomes less frequent; the respiratory movements are fewer in number and are almost wholly thoracic, not abdominal; all the secretions are reduced in quantity; the gastric and intestinal peristaltic movements are less rapid; the pupils of the eye are contracted and during profound sleep are not affected by light; and the eyeballs are rotated upwards. The pupils dilate slightly when strong sensory or auditory stimuli are applied, and they dilate the more the lighter the sleep; at the moment of waking they become widely dilated. Whilst muscular relaxation is general, there seems to be increased contraction of certain sphincter muscles, as the circular fibres of the iris and the fibres concerned in closing the eyelids. The state of the circulation of the brain has been frequently investigated. The older view was that there was a degree of plethora or congestion of the vessels of the brain, as is the state of matters in coma, to which the state of sleep has a superficial resemblance. Coma, however, is not sleep, but a condition of inactivity of the cerebral matter owing to the accumulation of dark venous blood in its vessels. This has been actually observed in cases where it was possible to see the brain. During sleep the surface of the exposed brain has been observed to become pale and to shrink somewhat from the sides of the opening (Johann Blumenbach, 1752-1840). A careful experimental research was conducted by Arthur E. Durham in 1860, in which he trephined a portion of bone as large as a shilling from the parietal region of a dog, and, to obviate the effects of atmospheric pressure, inserted a watch glass into the aperture so that the surface of the brain could be seen. His results are summarized thus: "(1) Pressure of distended veins on the brain is not the cause of sleep, for during sleep the veins are not distended; and, when they are, symptoms and appearances arise which differ from those which characterize sleep. (2) During sleep the brain is in a comparatively bloodless condition, and the blood in the encephalic vessels is not only diminished in quantity, but moves with diminished rapidity. (3) The condition of the cerebral circulation during sleep is, from physical causes, that which is most favourable to the nutrition of the brain tissue; and, on the other, hand, the condition which prevails during waking is associated with mental activity, because it is that which is most favourable to oxidation of the brain substance, and to various changes in its chemical constitution. (4) The blood which is derived from the brain during sleep is distributed to the alimentary and excretory organs. (5) Whatever increases the activity of the cerebral circulation tends to preserve wakefulness; and whatever decreases the activity of the cerebral circulation, and, at the same time, is not inconsistent with the general health of the body, tends to induce and favour sleep. Such circumstances may act primarily through the nervous or through the vascular system. Among those which act through the nervous system may be instanced the presence or absence of impressions upon the senses, and the presence or absence of exciting ideas. Among those which act through the vascular system may be mentioned unnaturally or naturally increased or decreased force or frequency of the heart's action." Dr William A. Hammond and Dr Silas Weir Mitchell (b. 1830) repeated and extended Durham's observations, with the same general results (1866), and Ehrmann, Salathe (1877), Francois Franck (1877) and Mosso (1881), by more refined methods of observation arrived at the same general conclusions. Angelo Mosso (b. 1846) in particular applied with great success the graphic method of registration to the study of the movements of the brain and of the circulation during sleep. He made observations on three persons who had lost a portion of the cranial vault and in whom there was a soft pulsating cicatrix. They were a woman of thirty-seven years of age, a man of thirty-seven years and a child of about twelve years. By special arrangements, Mosso took simultaneous tracings of the pulse at the wrist, of the beat of the heart, of the movements of the wall of the chest in respiration, and of the movements of the denuded brain. Further, by means of the plethysmograph - an instrument of Mosso's own invention - he obtained tracings showing changes in the volume of the hand and forearm; and he succeeded in showing that during sleep there is a diminished amount of blood in the brain, and at the same time an increased amount in the extremities. He showed further that there are frequent adjustments in the distribution of the blood, even during sleep. Thus a strong stimulus to the skin or to a sense organ - but not strong enough to awaken the sleeper - caused a contraction of the vessels of the forearm, an increase of blood pressure, and a determination of blood towards the brain; and, on the other hand, on suddenly awakening the sleeper, there was a contraction of the vessels of the brain, a general rise of pressure, and an accelerated flow of blood through the hemispheres of the brain. So sensitive is the whole organism in this respect, even during sleep, that a loudly spoken word, a sound, a touch, the action of light or any moderate sensory impression modified the rhythm of respiration, determined a contraction of the vessels of the forearm, increased the general pressure of the blood, caused an increased flow to the brain, and quickened the frequency of the beats of the heart. These observations show how a physiological explanation can be suggested of the influence of external impressions in modifying the dreams of a sleeper. Further, Mosso found that during very profound sleep these oscillations disappear: the pulsatory movements are uniform and are not affected by sensory impressions, and probably this condition exists when there is the absolute unconsciousness of a "dead" sleep. By such methods as have been employed by Mosso, three movements of the brain have been observed - (r) pulsations, corresponding to the beats of the heart; (2) oscillations, or longer waves, sometimes coinciding with the heart beats, or more generally consisting of longer festoons, carrying each a number of smaller waves, and believed to correspond generally to the respiratory movements; and (3) undulations, still longer and less marked elevations and depressions, first clearly observed by Mosso, and believed by him to indicate rhythmic contractions of the vessels of the pia mater and of the brain. This view is in keeping with the observations of Franz Cornelius Donders (b. 1818), Adolf Kussmaul (b. 1822), Tenner and others on changes of calibre observed in the cerebral vessels, and with the experiments of many physiologists, showing that the vessels of the pia mater, like other vessels, are controlled by the vaso-motor system of nerves. It may therefore be considered certain that during sleep there is an anaemia, or partially bloodless condition, of the brain, and that the blood is drawn off to other organs, whilst at the same time this anaemic condition may be modified by changes in the circulation or in the respiratory mechanism caused by position, by sensory impressions or by sudden changes in the state of repose of the muscles. The examination of the retina (which may be regarded as a cerebral outwork) by the ophthalmoscope during sleep also shows a comparatively bloodless condition. Such are the facts; the deficiency in the way of a theoretical explanation is that physiologists cannot satisfactorily account for the anaemic condition causing unconsciousness. Sudden haemorrhage from the brain and nerve-centres, or a sudden cessation of the supply of blood to the brain, as occurs in syncope (failure of the heart's action - a faint), no doubt causes unconsciousness, but in these circumstances there is a tendency to convulsive spasm. Such spasm is usually absent in sleep, but sudden jerks of the limbs may sometimes be observed during the time when there is the confusion of ideas preceding the passage into sleep.

During sleep the amount of carbonic acid eliminated is very much reduced, indicating that molecular changes in the tissues do not occur to the same extent as in the waking state. This is also shown by the fact that less heat is produced. Hermann von Helmholtz (b. 1821) states that the amount of heat produced by a man weighing 67 kilogrammes (14741b) is about 40 calories per hour during sleep, as against 112 calories per hour while awake. This diminished production of heat may be largely accounted for by the quiet condition of the muscles of locomotion, but it also indicates diminished tissue changes throughout the body. In profound sleep the bodily temperature may fall from 6° to 2° Fahr. In consequence of diminished oxidation changes during sleep, it is not improbable that excess of nutrient matter may then be stored up in the form of fat, and that thus the proverb "He who sleeps dines" is based on a correct appreciation of the fact that sleep tends to produce plethora or obesity.

Whilst it is easy to state that sleep is caused by fatigue of the nervous system, it is more difficult to explain what the precise changes are that produce the state of unconsciousness. Various hypotheses have been advanced, but it cannot be said that any one is wholly satisfactory. Aware that the fatigue of muscle is associated with the accumulation of sarcolactic acid, Thierry William Preyer (b. 1841) surmised that the activity of nervous matter might be interfered with by the accumulation in the nervecentres of some such acid, or of its soda salt (lactate of soda), but this view has not been supported by the results of experiment, as the injection into the blood of a dose of lactate of soda has not produced sleep. Pfliiger has observed that frogs deprived for a considerable time of oxygen passed gradually into a state resembling profound sleep, and he has advanced the theory that there is no organ of the body so quickly affected by deprivation of oxygen as the brain. According to Eduard F. W. Pfliiger (b. 182 9), the phenomena of life depend on a dissociation of living matter, and in particular the activity of the cerebral substance connected with psychical states depends on dissociation changes in the grey matter. To excite the dissociation, however, oxygen is necessary. The oxygen unites with certain of the compounds set free by the dissociation, forming, amongst other substances, carbonic acid. If such matters as these that unite with oxygen are in sufficient amount to use up all the oxygen, the grey matter of the brain suffers from a deficiency of oxygen (or from its absence), and also from the accumulation of carbonic acid. According to such a theory, cerebral activity depends on cerebral respiration, and sleep is a kind of cerebral asphyxia. Some such condition is not improbable, but it must be stated that the evidence at present in support of it is meagre. Possibly, in attempting to account for the phenomenon of sleep, too much importance has been attributed to the changes occurring in the brain, forgetting that not merely brain matter but every tissue of the body becomes exhausted by work, and that sleep may be partly due to phenomena occurring throughout the body and not in the brain alone.

All the phenomena of sleep point to a diminished excitability of the cerebral nerve-centres and of the spinal cord. Contrary to what is often stated, there can be no doubt that reflex action is in partial abeyance and that the spinal cord is in a state of partial inactivity as well as the brain. The only nerve-centres that do not sleep are those absolutely essential to life, such as those connected with the heart, with respiratory movements, and with the distribution of blood by the vaso-motor arrangements; and Mosso's experiments indicate that even these have a certain amount of repose in profound sleep.

There is little doubt that all living beings require periods of repose alternating with periods of activity. Many plants close their flowers and bend their petioles at certain times of the day. These phenomena, called "the sleep of plants," depend apparently on changes in solar radiation, and there is no reason to believe that during the time of quiescence any reparative processes go on, as during the sleeping period of animals. Naturalists have observed many of the lower animals apparently in a state of sleep. Insects, crustaceans, fishes, reptiles, may all be observed occasionally to be almost motionless for considerable periods of time. The sleeping of birds is familiar to all, and in these there are anatomical arrangements by which the bird may, like the crane, sleep perched on one leg, or grasping a branch with both feet, like perching birds generally, without any muscular effort and consequently without fatigue.

The amount of sleep required by man varies according to age, sex and habit. The popular notion that a child sleeps half its time, an adult one-third, whilst an old person may do little except eat and sleep is not far wrong. In early life the cerebral faculties appear to be easily exhausted and during the frequent and prolonged sleeps of infancy the brain rests and the vegetative changes connected with nutrition and growth go on actively. As life advances, less sleep is required, until in adult life a period of seven or eight hours is sufficient. As a rule, women require more sleep than men; but much depends on habit. Thus most women bear the loss of sleep in the first instance better than men, because they have been accustomed more to loss or irregularity of sleep. The effect of habit is well seen in nurses, both male and female, who will often be able to work for weeks continuously with snatches of sleep, not amounting to more than two or three hours daily. Sooner or later, however, even in these cases nature asserts her demands, and prolonged sleep is necessary to maintain health and vigour. Wakefulness during the time when one ought to be asleep is frequently a distressing condition, undermining the strength and incapacitating for active and efficient work (see Insomnia).

It is a matter of common observation not only that certain persons require more sleep than others but that they have less power of resisting its onset and of awaking. This condition may become morbid, constituting a veritable nervous disease, to which the name "maladie du sommeil" or hypnosia may be given. It may be described as invincible sleep, and it may continue for weeks and for months, terminating in convulsive seizures, and even death. A persistent drooping of the upper eyelid has been observed even during waking hours. Dr W. Ogle has observed in such cases an engorgement of the cervical ganglia of the sympathetic; but this may have nothing to do with the condition. Cases of very prolonged sleep are not uncommon, especially amongst hysterical persons, lasting four, seven or ten days. On awaking the patient is exhausted and pale, with cold extremities, and not infrequently, after a brief interval of waking, passes off into another lethargic sleep. Something similar to this may be seen in very aged persons towards the close of life. (See also DREAMS, SOMNAMBULISM and HYPNOTISM.) Among older works, see article "Sommeil" in the Dictionnaire encyclopedique des sciences medicales, where a bibliography is given and where also there is an account of the medico-legal questions connected with sleep and somnambulism; Macnish, Physiology of Sleep; Durham, "On the Physiology of Sleep," in Guy's Hospital Reports (1860); Kohlschiitter, "Die Mechanik des Schlafes," in Z. f. ration. Med., vol. xxxiii. (1869); Pfliiger, "Theorie des Schlafes," in Pfliiger's Archiv, vol. x. (1875); Mosso, Ober den Kreislauf des Blutes im menschlichen Gehirn (Leipzig, 1881). Also Manacelne, Sleep, its Physiology, Pathology, Hygiene and Psychology (Eng. trans. 1897), with bibliography. (J. G. M.)