Sleep and Its Derangements

by William A. Hammond

It has also been asserted that there is an exaltation of the sexual feeling during sleep. It is difficult to arrive at any very definite conclusion on this point, but it is probable that here again the position of the body conjoined with the heat of the bed has much to do in producing the erotic manifestations occasionally witnessed. Every physician who has had much to do with cases of the kind knows that sleeping upon the back, by which means the blood gravitates to the generative organs and to the lower part of the spinal cord, will often give rise to seminal emissions with or without erotic dreams, and that such occurrences may generally be prevented by the individual avoiding the dorsal decubitus and resting upon one side or the other while asleep. The erections which the generality of healthy men experience in the morning before rising from bed are likewise due to the fact that the recumbent posture favors the flow of blood to the penis and testicles. Such erections are usually unaccompanied by venereal desire.

The ganglionic nervous system and the spinal cord continue in action during sleep, though generally with somewhat diminished power and sensibility. The reflex faculty of the latter organ is still maintained, and thus various movements are executed without the consciousness of the brain being awakened. Somnambulism is clearly a condition of exaltation in the functions of the spinal cord without the controlling influence of the cerebrum being brought into action. But, aside from this rather abnormal phenomenon, there are others which are entirely within the range of health, and which show that the spinal cord is awake, even though the sleep be most profound. Thus, for instance, if the position of the sleeper becomes irksome, it is changed; if the feet become cold, they are drawn up to a warmer part of the bed; and cases are recorded in which individuals have risen from bed and emptied a distended bladder without awaking.

The instances brought forward in a previous chapter of persons riding on horseback and walking during sleep show the activity of the spinal cord, and not that the will is exercised; and Cabanis[33] is wrong in the view which he gives of such phenomena in the following extract.

Speaking of cases like those just referred to, he says:

“These rare instances are not the only ones in which movements are observed produced during sleep by that portion of the will which is awake; for it is by virtue of certain direct sensations that a sleeping man moves his arm to brush away the flies from his face, that he draws the cover around him so as to envelop himself carefully, or that he turns in bed till he has found a comfortable position. It is the will which during sleep maintains the contraction of the sphincter of the bladder, notwithstanding the effort of the urine to escape.”

Such examples as the above we now know to be instances of reflex action, and as not, therefore, being due to the exercise of the will.

Sleep favors the occurrence of certain pathological phenomena. Thus individuals affected with hæmorrhoids have the liability to hemorrhage increased when they are asleep. Several instances of the kind have come under my notice. In one the patient lost so large a quantity of blood that syncope ensued and might have terminated fatally had not his condition been accidentally discovered. Bleeding from the lungs is also more apt to occur during sleep in those who are predisposed to it. Darwin states that a man of about fifty years of age, subject to hæmorrhoids, was also attacked with hæmoptysis three consecutive nights at about the same hour—two o’clock—being awakened thereby from a state of very profound sleep. He was advised to suffer himself to be roused at one o’clock, and to leave his bed at that hour. He did so with the result not only of entirely breaking up the hemorrhagic disposition, but also of curing himself of very violent attacks of headache, to which he had been subject for many years.

Epileptic fits are also more liable to occur during sleep than at other times, a fact not always susceptible of easy explanation. In a case of epilepsy now under my charge, this proclivity is so well marked that the patient, a lady, scarcely ever goes to sleep without being attacked. Her face becomes exceedingly pale just before the fit, and if then seen the paroxysm can be entirely prevented by waking her. She is never attacked at other times, and I am trying, with excellent results thus far, the plan of making her sleep altogether during the day and of waking her as soon as her face becomes pallid. It is probable that the fits in her case are due to a diminished amount of blood in the brain, and this supposition is strengthened by the additional fact that bromide of potassium—a substance which, as I have shown, lessens the amount of intracranial blood—invariably rendered her paroxysms more frequent and severe.

Sleep predisposes to attacks of gout in those who have the gouty diathesis, and likewise favors exacerbations in several other diseases which it is scarcely necessary to allude to specifically. The accession of fever toward night, and the increase which takes place in pain due to inflammation are generally associated with the approach of night, and have no direct relation with sleep.

Certain other morbid phenomena, such as somnambulism and nightmare, which have a necessary relation with sleep, will be more appropriately considered in another place.