Sleep and Its Counterfeits.

Woods Hutchinson in American October 1 1907

Sleep and Its Counterfeits.

Woods Hutchinson in American October 1 1907

Sleep and Its Counterfeits.


Woods Hutchinson in American

SLEEP, after thirty centuries of study and thirty thousand of experience, is still a mystery. We know all about it, but nothing of it. The results of our most laborious researches, our most painstaking studies, are mainly negative.

One great positive fact, however, emerges from the negations of all theories; sleep is not a negative process but a positive one, not a mere cessation of activity, but a substitution of constructive bodily activity for destructive. The “anabolic” or up-building processes are in excess of the “katabolie” or downbreaking processes during sleep. During the working hours the balance is reversed. Sleep is a recharging of the body-battery.

It is the positive, constructive character of sleep which explains why babies at the period of their most rapid growth and development sleep from sixteen to eighteen hours out of the twentyfour, a capacity which steadily diminishes until adult life is reached, when it becomes constant, in the neighborhood of nine hours. At the other end of the scale of life, the well-known light sleeping and early awaking, characteristic of old age, is due to a loss of this reconstructive power. It is not that an old man does not need so much sleep as the child or adult, but that he can’t get it—has lost, to a degree, the capacity, and the reconstructive processes involved therein. The dozings and drowsings of old people during the day are mild torpors from exhaustion, not true sleep—forerunners of the final ending of consciousness.

It is the positive reconstructive quality which accounts for the differences in the quality of sleep which we have all experienced. A nap of an hour when conditions are favorable will often rest and refresh us as much as a whole night’s restless, dream-ridden slumber at other times. It is also the basis of the well-known ability of vigorous, healthy men to get along with exceed-

ingly small amounts of sleep. Some exceptional individuals have been able to do immense amounts of work with only four hours ’ sleep out of the twentyfour, and keep this up for years without apparent harm.

So, generally, has this positive factor been overlooked in popular literature that it has given rise to a whole series of misleading analogies. Confusion has been allowed to creep into popular and even scientific literature between the drowsiness and coma of fever, and other morbid conditions, and true sleep. These conditions are abnormal, as a rule injurious, and in no sense tend to reconstruction. A typhoid-fever patient who has apparently slept two-thirds of the time for two weeks will wake up with a loss of twenty or thirty pounds weight, weak as a kitten, emaciated, wretched. The vast majority of these drowsy, so-called sleepy, comatose conditions—the unconsciousness of fever, of exhaustion, etc.—are totally different from and in opposition to true sleep.

The most dangerous of all counterfeits of sleep are induced by drugs. It goes without saying that there is no drug that can produce sleep any more than growth, appetite or strength. There are many which produce a state of unconsciousness resembling sleep, and some of these are unfortunately much resorted to for this purpose. Though permissible in skilled hands their habitual use is dangerous, both because they are all poisons—weak ones, it is true, but true poisons, and because they smother a symptom, suppress a danger signal, without doing anything to relieve the diseased condition which caused it. The man who cannot sleep is sick, and should reform his habits.

“How much sleep shall I take in the twenty-four hours?” This can be answered unhesitatingly in five words, “As much as you can.” Here no competent authority would question the absolute safety of instinct as a guide. As the period of sleep represents the time

necessary to restore the oxygen balance of the tissues, to recharge the battery, then obviously it must last until that process has been completed, as attested by the familiar sense of “restedness” and refreshment. “Go to sleep when you ’re tired, get up when you wake feeling rested,” contains the philosophy of the whole problem.

Obviously no hard and fast rule as to the number of hours required can be laid down. Just as individuals differ in the color of their hair and eyes, the vigor of their appetites, their tendency to be fat, or lean, so they differ in the rapidity of their recuperation during sleep. As has been already mentioned, a few vigorous, energetic individuals seem able to recuperate with such rapidity that as little as four hours’ sleep suffices them. To mention a few notable instances, Frederick the Great, Napoleon, and his conqueror the Duke of Wellington, John Wesley, and in recent years, Edison, the inventor, were able to refresh themselves completely within this time. On the other hand, anemic and nervous individuals may recuperate with such extreme slowness that they require ten, twelve, or thirteen hours of sleep properly to redress the balance.

At a rough working average it may be stated that the majority of vigorous adults require an average of about nine hours. Women require from half an hour to an hour more than men of their age. Any attempt to shorten this necessary period, whatever it may be, which can readily be ascertained by each individual experimentation, is not only irrational but suicidal.

As a matter of fact, the average amount of sleep taken by most individuals is in the neighborhood of nine hours. The proverbs are, as usual, at sea, and have about the usual amount of influence over actual practice. “Seven hours for a man, eight for a woman, and nine for a fool,” has been their dictum for centuries, but the average human being cheerfully plunks himself into the “fool” class, much to his benefit. I believe that the usual eight-hour average laid down in the text-books errs on the side of brevity, and the majority of men in active work

take more than this or else suffer for it. The average laboring man goes to bed at between 8.30 and 9.30, or, if he does not, often falls asleep in his chair about 7.30 or 8, and sleeps until 6. The average business or professional man goes to bed about 10 and rises about 8. Each class enjoys on an average nine and ten hours, respectively. How the superstition ever grew up that there is such a thing as weakening yourself by oversleeping I cannot imagine. Whatever may have been the source of the delusion it is utterly without basis in physiology. No one ever got too much healthy, natural sleep, or injured himself physically by staying in bed until he felt rested. It must, of course, be remembered that sleep in stuffy, ill-ventilated rooms may never produce this sense of being rested, no matter how long it is prolonged. But, again, it is not the length of sleep, but the quality which is at fault. More than this, a great majority of men and all women would be benefited by a nap of from twenty minutes to an hour after the midday meal. In the case of women who are able to control their time, this should be insisted upon as a daily rule. Many men are unfortunately so situated that for business reasons this rest cannot be obtained, but they should make an effort to obtain it even if they do not fall asleep in the time.

This average of nine hours, of course, applies only to adults. For children it is impossible to lay down any fixed rule whatever. In the earliest days of infancy, fifteen to eighteen hours are required for the recuperative process. So astoundingly somnolent are young babies that I was once consulted by an anxious father who expressed great uneasiness lest his baby’s brain should not develop properly because it slept so much of the time. Needless to say, it was his first. From this the period gradually falls until by the third year it has reached the neighborhood of twelve hours, and by the fifth year, ten. But these again are to be taken only as the crudest of averages, as individual children differ enormously, according to their vigor, rate of growth, time of year, etc. A baby or young child should have absolutely every minute of sleep that it

can be induced to take, and sleeplessness is even more emphatically a sign of disease in children than in adults. This necessity and capacity for large amounts of refreshing sleep persists up to adult life, and the amount required seldom falls below ten hours before the eighteenth or twentieth year.

To make children or rapidly growing young adults get up before they have had their sleep out, and feel thoroughly rested, is not merely irrational but cruel, and when it is done as a routine practice at boarding schools, or other institutions, by those who pretend to be fitted to have the care of children, it is little short of criminal.

When is this sleep to be taken? For choice, and as a matter of convenience on various grounds, sometime within the hours of darkness, just when makes no difference. There is no adequate foundation for the popular belief that the “beauty sleep” is that which is taken before midnight, still less that one hour of sleep before midnight is worth two after. This impression has grown up upon economic and moral grounds connected with the early-rising fetish, and has no basis in physiology except in so far as it is involved in retiring sufficiently early to enable one to secure the requiste sleep-period before the hour of compulsory rising. It has been demonstrated by numerous experiments that the depth of sleep rapidly increases from its beginning to about the beginning of the second hour, then almost as rapidly diminishes until the middle of the third, after which it remains at practically the same level until the hour of waking. Some observers have reported a second increase in the depth of slumber about the second hour before waking, but this does not seem constant. Although as tested by the loudness of the noise required to awaken the sleeper, the depth of sleep is greater during the first three hour, it does not appear that the process of recuperation is going on any more rapidly during this part of the sleep period. Indeed1, all experiments which have been made, and practical experience as well, indicate that the last two hours of sleep give fully as much recuperation as the first two. It is by

no means infrequent that individuals will wake, from various causes, at the end of the sixth or seventh hour, with a distinct sensation of being unrefreshed, with, perhaps, a slight headache, which will have completely disappeared after two hours’ more sleep.

Strange as it seems there does not appear to be any necessary physiological connection between sleep and the hours of darkness. As a matter of convenience, most tribes and races have fallen into the habit of taking their period of rest at night, because the occupations necessary for securing food and a living are more advantageously carried out during the daylight. It is, however, perfectly practicable to reverse this completely, working during the hours of darkness and sleeping during the day for considerable periods of time without any apparent injury. That this habit, if persisted in for months, as in the case of night-watchmen, firemen, railroad men, etc., is apt to cause anemia and neurasthenia, is due to the loss of sunlight involved. Animals,'of course, are perfectly indifferent, often habitually turning night into day. Most species simply utilize for sleep such part or parts of the twenty-four hours as are not needed for securing food.

To that most acutely personal question, “How early shall we get up in the morning?” physiology has little to say in answer. If under the stern stress of work-a-day life it is obligatory for any individual to arise at an early hour, all it can advise is to be to bed at such an hour as will enable him to get his nine hours’ sleep before that time.

But that there is any advantage in early rising as such there seems little ground for believing. By the way its praises have been sung in proverb and homily one would think that it was the chief of the virtues, but its claims have little basis in physiology. Its virtues are purely economical, commercial, and its rank among the virtues is a survival from hard-fisted agricultural ancestors, whose work had to be done in daylight. Naturally it became a principle with them to get as much of this as possible. It also appealed to their commercial instinct in another sense, as it was regarded as the highest and most praiseworthy

economy to “burn daylight instead of candles.” These influences have combined to elevate to a pinnacle of virtue a habit which is merely a money-making one.

One of the principal arguments in its favor, that it is natural to rise with the sun and go to bed with the same, is so absolutely irrelevant that it needs no discussion. We have neither the endurance of that distinguished traveler, nor is his appearance in any way the signal for the beginning of our activities or his disappearance for their close. Nor can the “good example” of animals and birds be quoted with any reason. Many of them don’t set it at all, but retire with the sunrise. Those that do —are simply where our ancestors were a million years ago. The longest step towards humanization was the discovery of fire and consequent ability to sit up late at night and consider things. Civilization and late hours always go hand in hand.

Nor is there any adequate support for the impression that the early morning hours are in any way more wholesome or healthy than later periods of the day. Except in summer time they are apt to be damp, foggy, chilly and among the least desirable hours of daylight. It is quite true that during the summer there is a sense of exhilaration about being abroad in these early morning hours, but this evaporates w7ith the dew and is apt to be succeeded by a corresponding depression and loss of working power later in the day. I have been observing my friends and patients for the past twenty years, in this respect, and am inclined to the opinion that not a little of the depression and nervousness which so commonly develop in hot weather is due to excessive exposure to light, from habits of early rising, inherited from agricultural ancestors, not counteracted by three to four hours ’ rest in darkened rooms in the middle of the day.

Secondly, that the exhilaration experienced during the early morning hours is an expensive luxury which has to be paid for later in the day. In fact, I have found, that as a general rule, to put it very roughly, the business or professional man who rises an hour before

half-past seven or eight, goes to bed, or loses his working power, an hour and a half earlier in the evening. Each individual has in the beginning of his day about so much working power stored up in his brain and muscle cells. If he uses this up with great rapidity in the early morning hours he naturally exhausts his stock the sooner in the afternoon or evening.

It is largely a matter of when a man wishes to be at his best. If his occupation is of such a character that he can clear off the brunt of his work in the early morning hours, then let him rise early. If, on the other hand, he requires full vigor and readiness of mind and body in the latter part of the day, or at night, then he must rise later to get it. Even in pure muscle-work it is false economy to work too long hours. The eight-hour-a-day factory-hand invariably turns out more work and of a better quality than the twelve-hour-aday man. Much more so in intellectual w^ork. A few hours at high tension and pitch accomplish more than a day’s “slogging.” It need, of course, hardly be pointed out that the stage of intellectual development of any community is in direct ratio to the lateness of the hours it keeps. All the activities, social, literary, convivial, philosophic, (that bring out what is best in man, are at their highest tide after eight in the evening.

As we know of no drug or procedure which can produce sleep, it is obviously absurd to expect any “sure cure” for sleeplessness. This is invariably a sign of disturbance of balance, or of incipient disease, and should be treated only by careful investigation and removal of its cause, when found. And there will be nearly as many causes as there are sufferers. We cannot even say what particular bad physical habit is most frequently to blame. So that the number of “good things to do for sleeplessness,” which have any wide application, is very limited.

The one procedure which most universally disposes to sound sleep, is one which is within the reach of all, and that is getting well tired. To work hard enough every day to get comfortably tired, particularly muscularly, is the

best cure for insomnia. Excessive fatigue may, of course, produce it. Sleep is not solely or even chiefly a matter of the brain, but of all the active tissues of the body and especially the muscles. We must be symmetrically fatigued, or, as we say, “tired all over,” in order to sleep well. While there are many exceptions, laboring men and all those engage 1 in active out-door occupations usually sleep well. Most of our “incomniacs” are men and women of sedentary habits. In fact, I have been sometimes inclined to suspect that sleep is even more a matter of the muscles than of the brain. Certainly the soundness of sleep of many professional and business men is directly related to the amount of muscular exercise in the open air which they have taken during the day. A brisk daily walk of from two to four miles is the most universally effective hypnotic. But even this rule has many exceptions.

Diet has little influence on sleep, except in so far as it may produce disturbances of digestion, and through these of the general balance of health. The hypnotic effects of certain foods, such as onions, lettuce, milk, etc., are chiefly imaginary. Even the time of the last meal of the day is of relatively little importance, except that it is well to let this be at least two or three hours before retiring. But even this rule has many exceptions, as many healthy laboring men habitually fall asleep over their pipes directly after supper, and' children, after poking the spoon into their little eyes, nod off over the tea-table, with the bread and butter still clutched in their chubby fists.

The processes of digestion probably go on more slowly during sleep, but they are perfectly carried out, as is illustrated by the almost invariable habit among animals of going to sleep directly after a meal.

Indeed, a moderate amount of food in the stomach or intestines seems to promote slumber. Many night-workers, for instance, sleep much better for taking a light or even full supper just before retiring.

It goes without saying that the bedroom should be well ventilated, especially in view of the heavy storing up of

oxygen in the tissues which goes on during sleep. All windows should be open from the top at least one, and better two to three feet, so that a gentle current of air can be felt blowing across the face. “Night air,” as Florence Nightingale pithily remarked, “is all the air there is to breathe at night.” It is just as pure and as wholesome as day air. Night fogs and rain are only injurious in so far as they frighten you into shutting your windows. No air that ever blew out doors is so dangerous, or poisonous, as that inside a bedroom with closed windows.

The temperature of the room should be about 55 degrees to 60 degrees F., if possible. If markedly below this the amount of covering required is apt to become so great as to interfere with the respiration of the skin. The clothing should be as light as is consistent with warmth, the mattress elastic but firm, the pillow as high as the breadth of the shoulder, so as to keep the neck and head horizontal or slightly above, when lying on the side. The good, hard common-sense of humanity has solved all these problems, and the modern hair mattress, or its equivalent, single pillow and blankets, or cheese-cloth-covered “comfort,” which can be cleaned and aerated by turning the hose on it, can hardly be much improved on. Beyond these there is no virtue whatever in hard beds, flat or no pillows, and cold bedrooms. Just another instance of the deification of the disagreeable. The boggy feather bed, collector of the perspirations and diseases of successive generations, the bolster, the eider-down quilt, the hard sail-cloth-like counterpane, both airtight, and the latter heavy as a board, have gone to the attic or the ash heap, where they belong, along with the four-poster and its curtains, the night cap and the warming pan. Relics all of a barbarism which was either too stupid or too stingy to warm its bedrooms. The colder the bedroom in winter, the less the windows are opened and the fouler the air.

As to dreams, the less said the better. Partly because we know so precious little about them, and partly because they are no part of normal sleep. It would also take a great many words to ex-

plain how little we know about them. All we can say of them is that they appear to be due, to put it crudely, to different areas of the brain, or tissues and parts of the body, varying in the degree of their fatigue and consequently soundness of their sleep. Either those functions, or regions, of the brain and body which have not been sufficiently exercised during the day, or on the other hand, those which have been overtaxed and unduly fatigued, may “stay awake'7 and make vague impressions on our consciousness. So far as dreams can be said to follow any law whatever, they seem inclined to be often either continuous, or revulsive, “like,77 or “contrary.77 Either weird and improbable continuations of our thoughts and occupations during the day, or more often wild rebounds into opposite, or widely different, fields. The merchant dreams of going to war, the miser of making love, the professor of making money, the gilded youth of thinking. Thus there is a faint physiologic basis for the belief that dreams “go by contraries.77 They certainly “go,77 or “come true,77 by that rule as often as by any other.

The troubled, or horrid, dreams which occur during sickness are probably due to the torturing of the brain-areas, in which the images conjured up are stored by the toxins with which the blood is loaded. Similarly the grewsome visions and nightmares, which embitter the slumbers of those under the stress of violent emotions and mental suffering, are due to similar action by the fatiguepoisons produced by these states. While perfectly normal sleep is dreamless, yet a moderate amount of dreaming, especially if the images evoked are of a pleasing, or indifferent, character, is quite compatible with good and refreshing slumber. The sleep which is accompanied by “good77 dreams, is usually restful, as is illustrated by the universal good-night wish of 11 Sweet dreams.7 7 The sleep attended by “bad77 dreams is apt to be disturbed and unrefreshing, which simply means that mild and harmless stimulations of the brainareas during sleep produce pleasing images, while stronger stimulations or injurious irritation by toxins evoke dis-

tressing, or painful, images. A wellknown illustration of the latter fact is the notorious connection between “gobberlins with glass-green eyes77 and cold mince-pie for supper.

Persistent or frequent bad dreams are, like insomnia, a sign of ill-health, and should be regarded and treated as such.

One thing more can fairly safely be said about average or healthy dreams, and that is that they are largely due to the condition of the skin, whether external or internal. Our alimentary canal or food tube, is, of course, only a long roll of the skin, tucked into the interior of the body for digestive purposes, our brain and spinal-cord another and solider fold, sunk in for telegraphic uses.

Slight changes in, or irritations of. the surface of the body, or the lining of the alimentary canal, are probably the starting points of most of our milder dreams. This faint impulse wakes up either the brain-area, with which it is directly connected, or the one which happens to be most nearly awake, and we are off.

Some of our common dreams seem to be directly traceable. Slipping down of the blankets is followed by dreams of Arctic relief expeditions or falling into snowdrifts. A gas-distended stomach, pushing up the diaphragm and compressing the lungs, produces dreams of “something sitting on your chest,77 or dramatic struggles against other forms of suffocation.

The common single dream, that of falling, falling, falling from a great height, to wake with a gasp of relief just as you are about to strike and be dashed to pieces, is probably due to the general muscular relaxation and falling of the head, arms, and limbs which accompanies settling down to sleep. Careful studies have shown that it almost invariably occurs during the first fortyfive seconds of sleep. A slip, or change of position, of a sixteenth of an inch, is enough to suggest the idea of falling to the brain. It “does the rest,77 and provides out of its swarming storehouse of images and precipices, flights of stairs, giddy mastheads, and other scenic effects. If the impression is not vivid enough to wake you, you “strike hot-

tom” with a delicious sensation of restful warmth and repose, just such as your tired body is getting from its “downy couch.”

The next common dream, which we have all had scores of times, which, as Dickens quaintly said, he was sure even Queen Victoria, with all her royal wardrobes full of clothes, must have also had, that of suddenly finding yourself in public half-dressed, seems almost equally traceable.

The dream, and we can all recall its mortifying vividness, is usually associated with insufficient, or displaced, bedclothes. This gives our drowsy braincortex the idea that we haven’t sufficient clothes on. Our arms and shoulders being completely covered by the close-

fitting upper half of the nightgown, the impression of unprotectedness comes most vividly from our unencased lower limbs, and the hint is enough. Our welltrained modesty takes furious fright and hinc illae lachrumae, “hence these weeps. ’ ’

We don’t know much about dreams, but we know enough to feel fairly sure that they have no relation to anything in the heavens above, or in the earth beneath, which is more than a hand’sbreadth outside of the sleeper’s skin.

Any beliefs or deductions based upon their assumed relation to things outside of this area are, from a biologic point of view, the purest and pearliest of moonshine.