PHYSIOLOGICAL 267 



normal concomitants. There is a general diminution of activity, as 

 seen in the slowed pulse, breathing movements, and chemical 

 routine or metabolism. There is also a reduction in food-canal 

 movements and in almost all activities except perspiration. There is 

 delay at the thresholds of the sense-organs and of the nerve- 

 centres; and consciousness is often switched off, so to speak. One 

 must try to distinguish concomitants of sleep from changes asso- 

 ciated with resting (e.g. lowered temperature), or with lying flat 

 (e.g. increased blood-pressure in the brain). 



In his recent masterly book on sleep, Dr. R. D. Gillespie does 

 good service in puncturing the prevalent exaggeration of the danger 

 of insomnia in man. It has often been said that a dog will die of 

 sleeplessness sooner than of starvation, and there is indubitable 

 evidence that enforced wakefulness may be fatal to an intelligent 

 animal. But there is not much evidence that prolonged sleeplessness 

 has either mental or bodily ill-effects in man. In a few cases there 

 has been a delirium, but after a good sleep the patient was all 

 righ4 again. Those who are sleeping very badly should recognise 

 that this is a danger-signal pointing to something that urgently 

 requires attention, but they should not brood over the idea that 

 the sleeplessness itself means a collapse. There are few well- 

 documented cases of very profound insomnia continued for 

 many days and nights; and room-mates of those who say in the 

 morning that they "never slept a wink" have often a different 

 story to tell ! 



Some disorders of sleep are so serious that a physician's counsel 

 should be sought for without delay. We refer to cases where the 

 difficulty of falling asleep is so prolonged and irksome that the 

 prospect of bedtime is almost a terror; to cases where people sleep 

 too much, not too little, or when they fall asleep at the wrong time 

 and in awkward situations ; to cases of habitual nightmare, recurrent 

 night-terror, frequent somnambulism, and so forth. These indicate 

 something in the way of brain disturbances, or something going 

 wrong in the body which puts the sleep centre out of gear. 



But quite apart from serious disorders, there is frequent failure 

 to get a good night's rest, and this is often a quite unnecessary 

 handicapping of daily vigour. 



We refer to cases where the "bad sleeper" tosses about "for 

 hours" before he becomes somnolent, or wakes up at frequent 

 intervals, or is pursued by bad dreams which may end in a con- 

 vulsive start or in profuse perspiration, or is given to talking in his 

 sleep, or rouses himself with difficulty and unrefreshed when the 

 alarum-clock sounds in the morning. Or sometimes it is merely that 

 the sleep is not sound enough, but is broken by trivial noises, or 

 seems to the bad sleeper to be continually invaded by a wearisome 

 repetition of often-repeated daily tasks and worries. Are there any 



