103 



Disturbed Sleep. 

 In connexion with the circulatory and the other 

 plienomena of disturbed sleep there are various categories 

 with regard to the degree in which the subject is able to 

 recall his dreams or is conscious of the disturbances after 

 awaking. 



1. There is no recollection of the disturbed sleep or 

 dreaming condition, though the presence of such was 

 clearly shown by observations on the sleeper — occurrence 

 of muttering, talking, groaning, movements of the face, 

 fingers, etc. ; reflex disturbances were evidently active in 

 pronounced degree. 



2. On awaking there is a sense of the sleep having been 

 uncomfortable and troubled, but there is no recollection of 

 dreaming having occurred. 



3. The fact of dreaming is remembered, but not the 

 definite sequence of the dream. 



4. Vivid dreams remembered in great detail. 



In all the above categories cardio-vascular disturbances, 

 etc., have been recognized in more or less marked degree. 

 These disturbances disappear at various periods after 

 awaking — often in a variable number of minutes. 



Distribution of the Changes in Disturbed Sleep. 



The incidence of the recorded disturbances upon the 

 various systems varies widely in different instances. 



The heart's action may be specially affected by the 

 impinging of nervous impulses on the cardiac regulating 

 centres in the medulla, etc. There may be much accelera- 

 tion of the pulse with comparatively little elevation of 

 arterial pressure; there may be a strong cardiac impulse, 

 with or without sensations of palpitation.* On the other 

 hand, the arterial tone may be mainly influenced, vaso- 

 constriction being chiefly instrumental in causing a large 

 rise of jiressure, attended in some instances by moderate 

 or slow heart rates; in accordance with Marey's law the 

 high blood pressure acts by increasing the controlling 

 influence of the vagus centre over the rate of beat. 

 A strong cardiac impulse and a large pulse wave may be 

 prominently in evidence. Again, both heart and arteries 

 may be markedly influenced, giving a high blood pressure 

 with strong and rapid cardiac beats, powerful cardiac 

 impulse, etc. 



The respiration is sometimes much altered in the way of 

 augmentation or irregularity, but there is no constant 

 association between these changes and the circulatory dis- 

 turbances ; there may be marked respiratory changes while 



• In contrast with the slowed pulse rate which is normal in the small 

 hours of the morning, there is sometimes an acceleration at this period, 

 apart from the development of abnormal rhythms, true tachycardias, 

 etc., and without evidence of the mere extensive disturbances of blood 

 pressure, etc., described in this paper. Such acceleration is probably 

 ascribable to reflex influences which have become operative during the 

 preceding period of sleep in the earlier part of the night. 



