Oct. io6g Dear I thou-ht of vou i-@,hen the author of the report cate in to see me -%.he other day. As you see, he has i=en-ued a better si-6eD machine. The n-.achine is beinc--used by co-au-uhor I knov; erou"'@h about s2.eep p'tl-.-,,siology to detect some mist5@7c-es in the text, but am sending you a co@ hopes you may be ,y in able to givt,@ -,ie a-7. confiden-ial evaluation. he reason I am asking yo,. to go to the trouble is that )is givi-np, a.redort on use of the machine in San Franc-Lsoo 2 Do vou think the machine .4Ls a lot-.. of hookum or may he have so:,-ethinp,? -he is an _(He says electronirer,gineer, Thanks for any help you can give. Sincerel'v. f OWL 4 le, Ile, e? Al e- 4@ ----------------- -C R-cM ELC. TRO-TH7-RAPY THE.RussiANS PIONEERED "S.LEEF! THERAPY" OVER THIRTY YEARS AGO, AND. HAVE TREATED MORE THAN 500,000 PERSONS IN SOME 300 SLEEP CLTNICS LOCATED IN VARIOUS 2 PARTS OF THEIR COUNTRY, AMERICAN SCIENTISTS HAVE BEEN SKEPTICAL OF CLECTROSLEEP BECAUSE OF TH.E WI.DE RANGE OF CONDITIONS WHICH THE RUSSIANS CLAIT-- TO BENEFIT. LIKE- WISE, THE RUSSIAN CHOICE OF THE NAME "ELECTROSLEEP" CRV- ATEO THE IMPR ESSION THAT IT WAS2 A MACHINE TO INDUCE NATU- RAL SLEEP BY ELECTRICAL STIMULATION, AND THAT AN EXTRA c - HOUR OR TWO OF NATURAL SLECP WAS RESPCi4SIOLC FOR ITS SU CESS. HOWEVER, THE RUSSIANS DIDN'T KNOW HOW OR WHY IT WORKED ON SUCH AN APPARENTLY UNRELATED GROUP OF AILMENTS 2BUT SINCE IT WAS FOUND THAT MANY OF THE OBSERVABLE AND MEASURABLE CHANGES THAT OCCUR WHEN AN INDIVIDUAL GOES FROM WAKEFULNESS TO SLEEP TOOK PLACE DURING STit,ULATION, THE NAME "CLECTROSLEEPI" PROBABLY SEEMED TO THrm AS A LOGICAL CHOICE. UNFORTUNATELY, WHEN AMERICAN INVESTIGA- ic-LtC-#ROSON,.-2SOLELY AS A SLEEP-INOUCING TORS TESTED THE MACHINE RATHER THAN A MODALITY FOR TREATING VARIOUS AIL- .,@MENTS AND FOUND THAT ONLY A PORTION OF T'HE SUBJECTS ACT- UALLY.FELL ASLEEPI THEY CONSIDERED THAT THE -.RUSSIAN CLAIMS WERE GREATLY EXAGGERATEDO HOWEVER, AT LONG LAST, AMERICAN DOCTORS ARE SHOWli\G INTEREST IN ELECTROSLEEP THERAPY BECAUSE OF THE LARGE AMOVIN OF AMERICAN RESEARCH ON SLEEP SINCE ABOUT "o TH:s INTEREST STEMMED FROM THE DISCOVERY OF A NEW KI.NO OF SLEEP AND FROT, A NUMBER OF INVESTIGATIONS OF THE EFFECTS OF SLEEP DEPRIVATI.ONO TMIS NEW KIND OF SLEEP IS MOST COMMONLY CALLED REM, DREAM2 OR DEEP SLEEP BECAUSE ITS MOST SALIENT FEATURES ARE RAPID EYE MOVEMENTS, DREAMING, AND EXTRE2ME MUSCLE RELAXATION. QUIET, OR SLOW-WAVE2 SLEEP IS SO NAMED BECAUSE OF THE ASS ENCE OF THE OCCASIONAL BODY MOVEMENTS OF REM SLEEP AND THE FACT THAT THE BRAIN WAVES HAVE MUCH LOWER FREQUENCIES. MODERN THEORIES ON SLEEP ARE DERIVED FROM A CONSIDERABLE AMOUNT OF RESEARCH USING THE ADVANCED TECHNIQUES OF ELECT2RONIC INSTRUMENTATION2 AND THIS RESEARCH DISCLOSES THAT THE ONSET OF SLEEP IS A VERY COMPLEX INTEGRAT ION OF MANY FACTORS WHICH INVOLVE BOTH EXCITATORY AND INHISIIO Y PROCESSE-S. THESE THEORIES ARE FAR FROM BEING COMPLETE2 BUT FOR THE PURPOSE OF THIS PAPER, AN ELEMENTARY DESCRIPTION OF 2 PHENOMENA WHICH ARE PERTINENT TO AN EXPLANATION OF ELECTRI- CAL STIMULATION ARE,PRESENTED HERE. THE STATE OF WAKEFULNESS IS MAINTAINED SY TWO ENTIRELY DIFFERENT TYPES OF ACTIVATORY PROCESSES WHICH ARE CALLED SENSORY STIMULATION,ANO TONIC FACILITATIONE IN SENSORY STIMULATION, THERE IS A FLOW OF INFORMATION 2 FROM THE SENSE ORGANS WHICH ARE LOCATED BOTH PERIPHERALLY AND INTERNALLY THROUGH THE THALAMIC NUCLEIS IN THE BRAINSTEM TO VARIOUS REGIONS IN THE BRAIN WHICH ARE SPECIFIC TO EACH TYPE OF INFORMATION* THE FLOW IS'CONTROLLED OR MODULATED BY THE SENSORY RECEPTORS, VARIOUS SYNAPSES, AND BY THE BRAINSTEM C'O6-'iTRDL..:CENTER. THESE STIMULI UNDER,-CERTAIN CONDITIONS ALSO riAY INDUCE A REVERSE FLOW FROM THE CEREBRAL CORTEX -io THE BRAINSTEM CAUSING FURTHER AROUSAL ACTIVATION. THE 014SET OF SLEEP MECHANISM STARTS WIT'H INHIBITION I-% THIS SYSTEM. VISUAL AND'AUDITORY STIMULI, MUSCL E TENSION, AND MOTOR ACTIVITY ALL HAVE STRONG AROUSAL ACTION WHICH ARE NORMALLY INHIBITED WHEN WE LIE DOWN AND RELAX IN A QUI ET., DARK ROOM. ARTIFICIAL INHIBITION OF-AUDITORY AND VISUAL STIMULATION IS MOST EFFECTIVELY ACCOMPLISHED BY HABITUATION OF SPECIFIC MONOTONOUS AUDITORY STIMULI AFTER SOME MINIMUM NUMBER OF CLICKS ARE HEARD, OR BY A FLASHING LIGHT REPEATED F2OR A PERIOD OF' 300 TO 500 SECONDS. A FAR SUPERIOR V'ISUAL STIMULUS, HOWEVER$ IS THE INDUCT.10N OF-VISUAL-IMAGES BY. ELECTRICAL STIMULATION OF THE OPTIC SYSTEM, SINCE THE FREQUENCY OF THE FLICKIR CAN SE'INCREASE 0 BY A FACTOR' OF ABOUT THREE BEFORE THE FLICKER DISAPPEARS BY FUSION. A sy-PRoOUCT OF THE HABITUATION OF THE AUDITORY AND VISUAL 2 SYSTEMS IS THE DEACTIVATION OF MUSCLE TENSION INDUCING A GENERAL RELAXATION4 THIS RESULT IS CONFIRMED NOT ONLY BY THE OBSERVED MUSCLE FLACIDITY BUT BY THE BRAIN-WAVE PATTERN AS PORTRAYED BY THE.ENCEPHALOGRAPH WHICH SHOWS A CHANGE FROM THE ACTIVATORY PATTERN OF WAKEFULNESS TO THE ALPHA FORM OF THE RELAXED STATF-.- THE'SENS2ORY SYS.TEM IS INACTIVE DURING SLEEP AND IF NO STIMULATION IS PRESENT SLEEP WILL FOLLOW. THIS PHENOMENON IS EXEMPLIFIED BY THF.' CASE OF A SUBJECT WHO, THROUGH INJURY, LOST THE SIGHT IN ONE EYE AND THE HEARING IN ONE EAR, WHO WOULD FALL ASLEEP EVENTUALLY WHENEVER THE-GOOD EYE AND EAR WERE COVERED AND PLUGGED RESPECTIVELY. 2 IN ORDER TO PREVENT UNWANTED SLEEP THE BRAIN IS PROVIDED WITH A CONTINUOUS STIMULATION WHITH ORIGINATES IN THE MESENCEPHALIC HEMISPHERE OF- THE.8-RAINSTEM. THIS TONIC FACILITATION WHICH KEEPS THE BRAIN AWAKE HAS A MAXI- MUM INTENSITY AFTER AWAKENING AND IT IS CONTINUOUSLY SUP- :-t'l@E-DAY WITH A MINIMUM MAGNITUOE@-AT BED PRESSED DURING -TIME* THE ORIGIN OF THIS SUPPRESSION OF TONIC FACILITATION IS RELATED TO THE NEED FOR RECOVERY WH'ICH PROGRESSES CURING THE DAY AND TERMINA TES IN SLEEP. THE TIME FOR RECOVERY RAt4GES FROM MAGNITUDES MEASURED IN MILLISECONDS, SUCH AS L THE NERVES, TO HOURS IN THE CASE OF THE HIGHEST LEVEL OF CEREBRAL ACTIVITY. THIS HIGHEST LEVEL IS FOUND TO OCCUR IN LEARNING AND CONDITIONING WHICH IS THE REASON FOR THE LARGE AMOUNT OF TIME SPENT By A BABY IN SLEEP. THIS ACTIVITY IS BELIEVED TO P2RODUCE CHANGES IN THE LARGE GLIAL. CELLS AND SYNAPSES IN THIS LEVEL$ AND THESE CHANGES ARE CONSIDERED TO PROGRESSIVELY SUPPRESS THE TONIC FACILITA- TION OF THE MESENCEPHALON DURING THE DAY, SO THAT WHEN THE' SENSORY STIMULI ARE CUT OFF, SLEEP WILL FOLLOW. SOME PROCEDURES USED BY SCIENTISTS FOR FINDING A CORRELAT'ION BETWEEN A SPECIFI2C REGION AND ITS FUNCTIONS ARE TO STIMULATE TilC FICCION WITII VARIOUS CHEMICALS OR CLECTIIICAL CURRENTS OF VARIOUS CHARACTERISTICS, -!kNO OBSERVE THE PHENOMENA PRODUCED; AND TO CUT OR REMOVE A SPECIFIC REGION AND OBSERVE THE CHANGE IN PHENOMENA BEFORE AND AFTER RE-STIMULATION, SOMETIMES SUPPLEMENTED2 BY APPROPRIATE ELECTRONIC INSTRUMENTATIONE WHEN THE MESENCEPHA-LON IS REMOVED IN ANIMALS A SLEEP-LIKE STATE CHARACTERIZED BY EYE CLOSURES MUSCLE RELAXATION, LOWERED PULSE AND RESPIRATION RATES-, AND INSENSIBILITY TO TACTILE PRESSURE HAS BEEN.PRODUCEO. THE SAME SLEEP-LIKE STATE kAS BEEEN INDUCED BY INSERTING 2MICRO ELECTRODES AND PASSING A LOW FREQUENTY CURRENT THROUGH THE toESENCEPHALON, IN REVIEW, IT HAS BEEN ESTABLISHED THAT THREE STIMUL I CAN PROVIDE'THE CONDITIONS FOR THE ONSET-@.OF SLEEPS NAMELY, AN AUDITORY MONOTONE FOR HASITUATING THE AUDITORY CORTEXI.AN ELECTRICAL FL-ICK8ER FOR RABITUATIN.G THE VISUAL CORTEX EITHER ONE OF WHICH WILL INDUCE A RELAXED ?OUSCULATURE AND A LOW FREQUENCY TLECTRICAL CURRENT W'HICH MUST PASS THR OUGH THE BRAINSTEM IN ORDER TO DEACTIVATE THE MESEN- CEPHALON. HOWEVER, A NEW PROBLEM EXISTS BECAUSE TWO DIFFERENT ELECTRIC CURRENTS FLOWING IN THE SAtfE RECION WILL INTERFERE WITH EACH OTHER. THIS PROBLEM WAS SOLVED SY SYNCHRONIZING THE TWO ELECTRICAL CU2ilRENTS. THIS .SYNCHRONIZATION PRODUCED AN AMAZING RESULT - THE ELECTRI- CAL FLICKER WAS TWICE AS BRIGHT IF THE LOW FREQUENCY CUR-. RENT THROUGH THE SRAINSTEM WAS THE SAME AS THE ALPHA RHYTHM, AN-0 IF THE FLICKER CURRENT FREQUENC'Y WAS FOUR TIMES THE ALPHA FREQUENCY. THE R;rSULTS'.WERE OPTINUM WHEN THE MONOTONE WAS ALSO SYN2CHRONIZED WITH THE TWO ELECTRICAL STIMULI. THE THREE SYNCHRONIZED STIMULI - AUDITORY MONO- TONE@ ALPHA DRIVE, AND ELECTRICAL FLICKER - INDUCE A STATE' OF RELAXATION, A SLEEP-LIKE STATE, OR SLEEP. CONCERN OVER LOSS OF SLEEP BY THE ARMED FORCES DURING WAR RESULTED IN NUMEROUS STUDIES ON THE EFFECTS OF SLEEP DEPRIVATION SINCE IT HAD-BEEN KNO2WN FOR A LONG TIME THAT SLEEP DEPRIV@NTION LEADS TO MAL-FUNCTIONI PERMANENT DAMAGE, AND FINALLY DEATH; AND ALSO THAT TEMPORAR@Y SLEEP LOSS- IS MADE UP BY INCREASED SLEEPING TIME DURING THE RECOVERY PERioo. THE MENTAL SYMPTOMS OF SLEEP LOSS FOLLOW A SLOW AND PREDICTABLE'PATTERN, AND THE CHANGES ACCELERATE AS TIME PA2SSES. SOME OF TH-E CHANGES FOLLOWING SL'EEP D'EPRIVATION ARE: INATTENTION, WEARINESS, LACK OF CONCEN- TRATION, LOSS OF MEMORY, SLURRED AND FAUCTY SPEECH, LIST- LESS BEHAVIOR, REDUCED MUSCULAR EXERTION, ANXIETY, SKIN SENSATIONS, WITHDRAWAL FR.OM REALITY, TIME DISORIENTATIONI VISUAL DISTORTIONS, ILLUSION$ HALLUCINAT IONS. SEVERE 0 PERSONALIT-Y;-CHANCa,F.Sl AND FINA:LY A PSYCHOTIC STATE. THE EEG's OF BRAIN WAVES SHOWED AN ALTERNATION BETWEEN THE ALPHA FORM AND THE SLOW SLEEP-LIKZ WAVES@ AND THESE AL- TERNATIONS ARE CALLED "MICRCSLEEPS". SLEEP IS PRECEDED BY' A DECLINE IN ACTIVITIES OR PCRFORMANCE AND BY SUBJECTIVE FEELINGS OF TIREDNESS, WHICH HAVE BEEN CONSIDERED TO BE DUE TO AN ACCUMULATION DURING WAKEFULNESS OF WASTE PRODUCTS WHICH ARE DISPOSED OF DURING SLEEP OR OF A DEPLETION DURING WAKFEULNESS OF VITAL CHEMICALS WHICH ARE REPLENISHED DURING -SLEEP* WHEN2 CERESROSPINAL FLUID FROM FATIGUED DOGS IS INJECTED INTO NON-FATIGUED DOGS$ THE LATTER SHOWED SIGNS OF DROWSINESS AND SLEEP, THUS INDICATING THAT A HYPNOGENIC SUBSTANCE ACCUMULATED DURING WAKEFULNESS* SEROTONIN, WHICH IS A tiMORt-,ONE"-LIKE SUBSTANCE EXHIBITING A WIDE RANGE OF' POWERFUL EFFECTS ON THE BRAIN AND OTHER ORGAN2S OF THE BODY, IS FOUND IN CERE8ROSPINAL FLUID. SIMILAR EXPERIMENTS' WITH WATER-SOLUBLE EXTRACTS FROM THE BRAINS OF SLEEPI,'qG' ANIMALS PRODUCED SLEEP IN THE RECIPIENT ANIMALS* THE MEDULLA AT THE BASE OF THE BRAINSTEM CONTAINS THE RAPHC NUCLEI WHICH ARE NOTED FOR THEIR PRODUCTION OF SEROTONIN* 2 WHEN 8OYo OF THE CELLS OF THESE NUCLEI ARE DESTRCYED THE EXPERIMENTAL ANIMALS SLEPT LESS THAN 10% OF THEIR NORMAL PERIOD. SIMILARLY9 THERE IS A LOCUS COERULEUS NUCLEUS JUST BELOW THE RAPHE NUCLEI WHI CH CONTAINS TH E SYSTEM FOR PRODUCING REM SLEEP, ANIO.THIS NUCLEUS USES NORADR.E2NALIN FOR ITS ACTIVATING AGENT* IT HAS BEEN LONG SUSPECTED THAT THERE IS ASTRONG LINK BETWEEN INSOMNIA AND MENTAL ILLNESS. IN ONE'TWO- -,-YEAR SURVEY OF SEVERAL HUNDRED MENTAL PAT'I'ENTS (WiTti PSYCHOSESI DEPRESSIONS, AND OTHER AILMENTS), IT WAS FOUND THAT Sl@o' OF THEM HAD BEEN SUFFERI2'NG FROM SLEEP DISORDERS, A,ND'MANY OF THEM WERE COGNIZANT THAT SLEEP LOSi'WAS THE CAUSE OF THEIR.AILMENT. !N ANOTHER STUDY OF A L'ARGE NUMBR@R OF PATIENTS HAVINC HEART SURGERY, IT WAS FOUND THAT A HOSPITAL le@ -NO PLACC TO FIND REST* PATIENTS COMPLAINED BITTERLY OF LACK OF SLEEP IN A BUSY WARD WITH HOURLY-MEO6ICAL CHECKS AND EXTENDED NURSING CAREO THIS STUDY DISCLOSED THE FACT THAT IN A THNCC TO FIVE.DAY POST-OPCRATIVE Pclii-ool OVCTI ofic- T III fi I) c)r T II C I'AT Ir.NTi II AI) III VI',1.011L I) IO A II A II O IO :;(J.'; 11 I C I ( lj!; 1)1.1 III I litt I 2[)I:;011 II. N I AI ION, A 141) IIAL I. UC I ti A r I oti. Wil IC If VA tl I'@IILU AI' III( I'l II. I'AT I t:N r WA:' III. AC I-1) IN A OU I 1:1 1(((11 WI T)i A 'fil(Ul'T I ON" TiiL:"L: AND OTIILII :;TUOir.- 2 MiNitium Nlititli:lt 01' INTI. -ilitints LO!'.:; or :;LLI:I' INTO I?OCUS A.'& AN IMIIOI(TANT rACTUft IN ML:DICAL 1114ACTICC SINCL TIIL SLCEP DCIAI(IVATION P@TUOIC'- SHOWCO TIIAT THE SYMPTOMS APPEARING2 WERE ESSENTIALLY THE SAME AS FOUND IN THE MENTALLY ILL.'-TmE IMPORTANT QUESTION IS, THEREFORE, WHICH KIND OF SLEEP LOSS IS THE CULPRIT* SEVERA L STUDIES OF REM SLEEP DEPRIVATION WERE MADE AFTER OVERCOMING THE DIFFICULTIES OF DETERMINING THE EXACT TIME THAT REM DREAMING STARTED AND ENDEDO WHEN AN INDIVIDUAL'GOES TO SLEEP, HI2S INITIAL QUIET SLOW-WAVE SLEEP LASTS FOR A PERIOD OF 60 TO 90 MINUTES AFTER WHICH HE STARTS DREAMING. THERE ARE NORMALLY FOUR OR FIVE OF THESE REM PERIOOSI IN WHICH THE FIRST ONE IS THE SHORTEST AND TliC LA'JT ONE IS TIIE LONGEST, AND ONLY TfiE DREAMS OF THE LAST ONE ARE RTMEMOCREO. THE TOTAL REM SLEEPING TIME IS, ON THE 2AVERAGE$ 20% OF THE TOTAL PERIOD. THESE STUDIE'S DISCLOSED THE AMAil.NG FACT THAT THE LOSS OF' REM SLEEP PRODUCED ESSENTIALLY THE SAME MAL-FUNCTIONING THAT OCCURRED WITH TOTAL SLEEP DEPRIVATION. THE SUBJECTS ACTUALLY SLEPT MUCH LONGER THAN USUAL IN THE QUIET SLOW-WAVE PHASES AND 'THE DISCOVERY THEY W2ERE EXTREMELY DIFFICULT TO AWAKEN. OF THIS BASIC PHENOMENON PROVIDES THE SCIENTIST WITHA New TOOL FOR ATTACKING SLEEP DISORDERS AND THEIR DERIVATIV-R. AILMENTS. THIS THIRD STATE OF CONSCIOUSNESS CAN SE E @-'G IDENTIFIED BY ITS SALIENT CHARACTERISTICS SUCH AS AN PATTERN RESEMBLING THAT O1F WAKEFULNESS) RAPID EYE MOVEME.%TS.1- OFTEN JERKING OF THE'LIMBS., MARKED F'LACIDITY OF NECK MUSCLr@S's AND ALMOST ALWAYS A REPORT OF DREAMING WHEN AWAKENED, THAT ANOTHER IMPORTANT FACET OF TOTAL SLEEP DEPRIVATION I THERE IS A CHANGE IN QUALITY OF SLEEP, AND THIS CHANGE IS FOR THE WORST S'INCE THERE IS A LARGER PERCENTAGE LOSS OF THE REM STATE. SLEEPING PILLS AND TRANQUILIZERS ARE USED IN LARGE QUANTITIES FOR THEIR HYPNOGENIC E2FF-ECTS., AND, SINCE THERE A-RE TWO KINDS OF SLEEP, INVESTIGATIONS WERE CONDUCTED ON THE KIND OF SLEEP WHICH THEY INDUCED* THE SURPRISING' RESULTS WERE THAT BARBITURATES, TRANQUILIZERS, AMPHETAMINES ND ALCOHOL SUPPRESS THE REM STATE-WHEN TAKEN REGULARLY. A WHEN REM SLEEP DEPRIVATION IS TERMINATED THERE IS A REBOUND IN THE2 RECOVERY PF'RIOD-SN WHICH THE SUBJECT TLEEPS FROM 11 TO 14 HOURS AFTER SEVERAL NIGHTS OF SLEEP LOSS WI TH A MUCH HIGHER THAN NORMAL PROPORTION OF REM SLEEP. WITH LONGER PERIODS OF DEPRIVATION THE PROPORTION OF REM IN- CREASED. ANIMAL STUDIES DETERMINED THAT AFTER REM SLEEP DCP141VATION THEY SECMEO TO RECOVER ABOUT 60@o2 OF' THEIR LOST DIII:AM FuliTill:li ';TUI)ir,@- wt-itc MAOL ON Till. ltf:COVLIIY l@Lititill lllil'.NUMLt4oN TJ!;ING T'WO cituui,,-,, or l(AT.1; UCIIIIIV(:I) 01' '@'LCCF F'olt l'Oul( Oli f'IVL UAY'@' WitLitE ONE GROUP WAS CIVLN A '@'LICHT EL.LCTiliC C@'IIOCK BY TOUCHINC TtiE ELECTRODE TO TIIE EAft.. THE UNSHOCKED CONTROL GROUP SHOWED THE USUAL INCRE!MENTAL @C 0 tip E SATORY PERIOD OF REM SLEEP BUT THE SHOCKED GROUP SPE.NT ARIUCH SMALLER PERIOD IN REM SLEEP. THIS KEY E@P'ERIMENT PROVIDES A NEW METHO0 .OF QUICKLY REMOVING RFM SLEEP DE,PR IVATION EFFECTS IN THE RAT WHICH WAS SUBSEQUENTLY VERIFIED IN THE CAT-NAI-ELY, 8-Y PASSING AN ELECTRICAL CURRENT THROUGH THE-HEAOS OF THESE 'THIS tXPtRIMENT SUGGESTS TH 0 ANIMALS* AT THE EL=CTRIC' CURRENT CAUSES THE RELEASE OF A COMPOUND THAT COULD BLOCK THE FLOW OF THE ACTIVATING AGENT'FOR REM SLEEPS WHICH 1.ikS BEEN IDCNTIFIEO AS NORADRENALIN. 'f.IT HAS BEEN K-'IIOWN FOR OMETime THA' THE PONTINE RETICULAR FORMATION CONTAINS s A TIMIN'@ DEVICE WHICH PRODUCES REM SLEEP AT RZGULAR. BUT WHI DURING WAKEFULNESSE INTERVALS CH IS INTERRUPTED IT HAS BEEN DETERMINED EXPERIMENTALLY THAT A SPECIFIC DOSE Of RESERPINE IN CATS LEADS TO A COMPL2ETE ELIMINATION' OF REM SLEEP FOR AS LONG AS FOUR DAYS. A POSSIBLE HYPOTHESIS IS2 THEREFORE, THAT THE ELECTRIC CURRENT COUNTERACTED.THE BLOCKING EFFECT OF A RESERPINE-LIKE SUBSTANCE OF EITHER THE TIMING DEVICE OR OF THE EXCRE- TION OF NORADRENALIN FROM THE LOCUS COERULEUS.REGION* IF THE CAUDAL PONTINE RETICULAR FORMATION IS CUT OR 2 REMOVED, REM SLEEP IS COMPLETELY ELIMINATED, BUT IF TtilS RCGION IS STIMULATED ELECTRICALLY WHILE MAN IS IN A SLOW 4LEEP-LIKE STATE, REM SLEEP WILL FOLLOW. IT IS POSSIBLE FOR STRONG AROUSAL STIMULI OR DRUGS, SUCH AS AMPHETAMINE, TO COUNTERACT THIS ELECTRICAL STIMULA- TioN. THUS, WE FIND THAT'ELECTRICAL STIMULATION OF THE BRAINS2TEM AFTER SENSORY HABITUATION LEADS TO A QUIRT SLEEP-ST-ATE FOLLOWED BY THE REM STATE IN WHICH SYMPTOMS OF REM SLEEP DEPRIVATION ARE REVERSED. THESE CHANGES ARE DRAMATIC IN A LARGE NUMBER OF-CASP'S FOR IN MANY INSTANCES A SINGLE ONE-ROUR STIMULATION COMPLETELY REVERSES THE SYMTOLOGY OF DEPRESSION AND OTHER SIMILAR MENTAL DISORDER2S INDUCING A STATE OF CALMNESS AND WELL BEING* T II Cl- I N I C AL Af- I"L I C AT I 0 N or @CL 1: CIt I C AL T I ML)L AT I 0 N TO MAN INTI@OUUCLe4 TkiC PIZOULLM OF PASSING AN CLCCTRICAL CUR- RENT THROUGH THE HEAD, BY MCANS OF EXTERNALLY ATTACKED' ELECTRODES INSTEAD OF THE USE OF INTRA0-@KULL MICRO- ELECTRODES PLACED IN A SPECIFIC REGION OF THE BRAINSTRM. THE SIZE OF THE RETICULAR FORMATION OF THE BRAINSTEM IS NO BIGGER THAN THE LITTLE FINGER, SO iT IS OBVIOUS THAT AN ELECTRICAL CURRENT FROM EXTERNAL ELECTRODES WOULD PASS C, ,=II, -mom THROUGH ALL REG'IONS OF THE RETICULAR FORMATION IF IT PASSED THROUGH THE GRAINSTEM AT ALL* ACCORDING TO OSCILLATOR THEORY, THE IMPEDANCE TO CURRENT FLOW IS A MINIMUM FOR FREQUENCIES APPROXIMATING THE SPONTANEOUS RHYTHMS2 AND THE RHYTHMS WHICH ARE-FOUND IN THE REGIONS IMPLICATED IN THE INDUCTION OF SLEEP HAVE 2 FREQUENCIES WHICH RANGE FROM LESS THAN CYCLE/StC. TO ABOUT 14 C'YCLES/sec. Fon EXAMPLE, THE WAVES IN THE PONTINC RETICULAR FORMATION DURING REM SLEEP ARE 6 TO (3 CYCLES/SEC., AND THE WAVES.FOR DROWSINESS ARE 8 T' o i2 CYCLES/SEC. WHICH ARE ESSENTIALLY THE ALPHA RHYTHM. 2 HowCVLft, THE MOST EFFECTIVE ELCCTKICAL FLICKC.@'Ffir'OUCt4CY' is 32 TO Li-O CYCLES/SCC. WHICH IS'.THE THIRD HARMONIC OF THE ALPHA RHYTHM, AND THEREFORE WILL PROVIDE MINIMAL STIMULATION OF STRUCTURES WITH SPONTANEOUS FREQUENCIES OF 8 TO 10 CYCLES/SEC. THUS, WE FIND THAT FOR OPTIMUM STIMU- LATION OF TH2E OPTIC NERVE AND THE BRAINSTEM RETICULAR FOR- @ATION, TWO OSCILLATORS ARE REQUIRED WITH A 4:1 FREQUENCY RAT IO THERE ARE 'E 'THE THRE LOW IMPEDANCE PATHS IN HEAD: JUST UNDER THE SCALPS THROUGH THE SURFACE AT THE BASE OF THE BRAINI AND ALONG THE OPTIC NERVE WHICH EX- 2TENDS FROM THE EYES TO THE V4SUAL CORTEX. ELECTRICAL FLICKER CAN BE INDUCED WITH MINIMAL CURREAT INTENSITY WITH ELECTRODES ON THE MASTOIDS BEHIND TaE EARS, WITH CORRESPONDING ELECTRODES OVE.R THE EYES, BUT THIS ARRANGE- MENT PRODUCES-PSYCHOLOGICAL EFFECTS, SUCH AS ANXIETY AS WELL AS THE SIDE EFFECTS. OF BLURRED VISION 4 I-N SO-ME PAT-1@E.NT-S, ..,,INF.RF-QUENT LARYNGEAL SPASr'.SS.JN ADDITION TO MINIMAL CURRENT IN THE BRAINSTEM. FOR MAXIMUM CURRE-14T IN THE BRAINSTEMS THE CURRENT SHOULD FLOW EITHER BETWEEN THE TWO MASTOIDS OR FROM AN ELECTRODE AT THE BACK OF THE HEAD AT THE BASE OF THE OCCIPITAL LOBE' TO FOREHEAD'OR TEMPLE ELECTRODES* THE LATTER ARRANCEPENT IS SUPERIOR BUT IT INTRODUCED 4 NEED FOR THE DEVELOPMENT OF A NEW'TYPE OF ELECTRODE FOR CARRYING CURRENT FROM THE SURFACE OF THE HAIR, WHICH IS PARTICULARLY THICK ON.WOMEN AND HIPPIESI TO THE SCALP. 'THe IDEAL FL2ICKER ELECTRODE ARRANGEMENT IS EITHER WITH TEMPLE OR FOREHEAD ELECTRODES, JUST OVER THE EYE$O SUMMARIZING THE PHENOMENOLOGY, WE FIND THAT SLEEP DISORDERS ARE THE GENESIS FOR A MAJOR PORTION @OF MENTAL ILLNESS AND THAT REM-STATE SUPPRESSION IS THF' ACTIVATING AGENT2 AND THAT MOST OF THE DRUGS FOR TREATIN2G MENTAL ILLNESS NOT ONLY 00 NOT HAVE MUCH CURATIVE VALUE BUT ARE THEMSELVES A PARTIAL CAUSE OF THE CONDITIONS WHICH THEY ARE SUPPOSED TO TREAT. APPR-OPRI-ATE:ELECTRICAL STIMULATION APPEARS TO PROVIDE THE BEST SOLUTION BECAUSE IT HAS NO SIDE EFFECTSS SUPPRESSES DRUG WITHDRAWAL REBOUNDL AND PRODUCES IMMEDIATE RELKEF OF SYMPTOMS 2IN A SUBSTANTIAL PROPORTION OF THE MENTALLY ILL* LOOKING AT THE CLINICAL APPLICATIONS OF REM ic-'LECTRO-TH.ERAPY, A GUIDING PRINCIPLE FOR PRortioSTICATitiC. ITS PROBABLE EFFICACY IN TREATING VARIOUS AILMENTS WOULD SE'TO LOOK'FOR CORRELATIONS BETWEEN THE REM DEPRIVATION PHENOMENA AND 2THE SYMPTOLOGY OF VARIOUS AILMENTS TEMPER@TO BY -THE KNOWLEDGE THAT THE MOOUS OPERAND$ OF REM ELECTRO- 6-RAPY INCLUDES: RAPID TH.L DISSIPATION OF REM HYPNOTOXINS, REHABILITATION DURING REM SLEEP,, AND THE SUGGESTIBILITY OF THE APPA$IATUS PER SEV THIS SUGGESTIBILITY rf-AY BE EITHER 0 FACILITATIVE OR COUNTERACTIVE DEPENDING ON THE THOUGHTS WHICH WILL BE BROUGHT INTO CONSCIO'USNESS BY ASSOCIATION WITH THE STORED MEMORIES OF PAST EXPERIENCE, FOR EXAI-.PLE, BEEN ICO@O THE PATIENT REACTION TO THE APPARATUS HAS COUNT ERACTIVE IN ALL CASES OF PATIENTS WHO HAV E PRE- VIOUSLY BEEN GIVEN ELECTRO-CONVULSIVE SHOCK TREATMENTS, ANOTHER EXAMPLE WHICH PROVIDES A QUANTITATIVE RESULT IS OSTAINED FROM A CLINICAL PRA2CTICE ANALYSIS OF ONE THOU- SAND PAT.IENTS I N JAPAN TREATED BY AN ELECTROSLEEP MACH- INE WHICH USED EYE ELECTRODES. THE APPARATUS PROVED TO BE COUNTERACTIVE TO ALMOST ONE-FOURTH OF THE PATIENTS SINCE IT WAS FOUND THAT 26.7% OF THEM SHOWED' NO CHANGE OR RESPONSE DURING OR AFTER TREATMENT, BUT NEARLY A2LL BECAME DROWSY OR SLEPT AFTER RESTIMULATION WHICH FOL- LOWED THE ADMINIS,TRATION OF'A MILD SLEEPING DRUG WHICH WAS INEFFECTIVE BY ITSELF. THE FACILITATIVE EFFECTS OF THE APPARATUS WERE DEMONSTRATED BY THE FACT THAT AFTER FOUR OR FIVE TREATMENTS, A SUBSTANTIAL NUMBER OF THE PATIENTS WENT INTO FIRST-STAG.2E SLEEP AFTER THE ELECTRODES WERE''ATTACHED BUT BEFORE THE CURRENT WAS TURNED ON. AN EXAMINATION OF ELECTROSLEEP CASE HISTORIES REVEALS THE.CONCLUSION THAT THE MAJORITY OF THE AILMENTS TREATED COULD BE DIVIDED INTO TWO DOMAINS - THE RI-M STATE AND THE N@"U.ROG5'NIC DOMAINS, WHERE2IN THE FIRST INCLUDES ALL CASES IN WHICH THE SYMPTOLOGY IS RELATED To R---M DE- PRIVATION PHENOMENA, AND THE'SECOND INCLUDES THOSE .ILL-. NESSES WHEREIN Rc@M ELFCTRO-THc-'.RAPY WOULD QNLY CONTRIBUTE NEUROGENICALLY TO THE RELIEF OF SYMPTOMS 'RESPECTIVELY. THE Rc-M STATE DOMAIN WOULD OBVIOUSLY INCLU2DE INSOI'.N'IAI DEPRESSION, SCHIZOPHRENIA., ETC., WHEREAS THE NEURCGF'NIC DOMAIN WOULD INCLUDE DERMATITIS, ULCERS, HYPERTENSION$ ETC.,, WHEREIN PHYSIOL-DGI--CAL CHANGES MIGHT ALSO BE IMP-ORTANT CAUSAL FACTORS.- A QUANTITATIVE EXAMPLE OF THE N.rURCGENIC DOP'AIN IS GI1VEN BY THE RUSSIAN STU-.DY OF 3?ro PATIENTS SUFFERING FROM ARTERIAL CONGESTION IN WHICH ELECTROSLE EP IMPROVEMENI TREATMENTS PROVIDED SYMPTOLOCICAL s i-N 520 OF THE@ CASES AND SLIGHT IMPROVE,-ICNT IN BRAIN TISSUE 13 CAPAOLE OF TOLERATI:JC --(JtIE TYPES OF STIMULATION OVER LONG PERIODS OF Ti.',!,-. TISSUE DAMAGE CAN OCCUR IN TWO WAYS@ VIZ., ELECTROLYTICALLY AND THERMALLY. ELECTROLYTIC D.AMACE OCCURS WITH ANY DIRECT 2 CURRENT STIMULUS AT ANY CURRENT.OENSITY, RESULT4NG IN DECOMPOSITION OF ELECTROLYTES AND DIFFUSION OF METAL I-%TO TISSUES. UNIDIRECTIONAL CURRENT PULSES CAUSE THE SAME DAMAGE BECAUSE SINGLE PULSES ARE CUMULATIVE OVER SHORT INTERVALS OF TIME. THE HISTORY OF ELECTRICAL STIMULATION OF THE PRAIN DISCLOS ES THAT SEVERAL FORMS OF ELECTRICAL CURRENT HAVE BEEN USED INCLUDING DIRECT,, ALTERNATINC, AND-UNIOIRI--CTIONAL PULSES. Toc)A@yl, THERE ARC THREE BASIC TYPES OF CURRENT IN USE - BALANCED$ UN3ALANCED RCCTANCULAR PULSCS, AND THE L:ATTER PULSES SUPERIMPOSE2D ON DIRECT CURRENT. A BALANCED Re.CTA.N'CULAR PULSE HAS A F ORWARO CURRENT EQUAL TO THE BACKWARD CURRENT WHICH WOULD BECOME AN UNBALANCED PULSE IF THE FORWARD AND BACKWARD F LOWS ARE UNEQUAL. AN UNBALANCED PUL'SE HAS A UNIDIRECTIONAL COMPONENT. TISSUE TOLERANCE STUDIES HAVE DETERMINED THAT BA2LANCED RECTANGULAR PULSES CAN PASS THROUGH TISSUE FOR AN INDEFINITE PERIOO.OF TIME, 'SUCH AS WOULD BE REQUIREO OF A PERMANENT 1.%IPLAqT PROV: DING THA" THE AMOUIYT'OF ELE-CTRICAL CHARGE IN EACH PULSE 010 NOT EXCEED 200 MICRO COULO-MSS. OBVIOUSLY$ MUCH LARGER CHARGES2 COULD BE USED FOR INFREQUENT STIMULATION. @.,OWEVER, kF THE PULSES AR,- UNIDIRECTIONAL, THE. CHARGF' PER PULSE FOR EQUAL TOLERANCE IS LESS THAN 20 MICRO COULOMBS. DATA ON DIRECT CURRCNT BIAS T'OLER%ANCE IS NOT AVAILAULL OUT or COUI('.'L TilL CO[ifirSi'ONDING CUi%I%C.NT2 4AGNI.TUL)E WOULO BE MUCH LOWER. THE LATEST PRIOR ART CLECTROSLEEP GENERATOR'> USE AN UNBALANCED PULSE WITH ;k 01-RECT CURRENT BIAS AND THEREFORF. WILL CAUSE ELECTROLYTIC 01-SSOCIATION .AND 'AEPOSITION OF METALLIC IONS IN THE BRAIN TISSUE. THE NATURE OF THE EFFECTS OF THIS DEOC8SITION IS SUGGESTED BY CONVULSIVE -RLECTRO-SHOCK TREATMENTS IN WHICH i".E,"ORIES OF CC.','Tc-r,.PORARY EXPERIENCE ARE DESTROYED. THE REASONS FCR THE MARGINAL BRAINS'AEM STIMULATION OBTAINED W ITH THESE GENERATORS ARE THAT THE EYES CAN ONLY TOLERATE A VERY SMALL CURRENT AND THAT ONLY SMALL CURRENTS SHOULD BE USED FOR MINIMAL IRREVERS13LE BRAIN TISSUE CHANCER@. THERE ARE TWO KINDS OF BALANCED PULSES SYtp-METRIC AND 'ASYMMETRIC WHEREIN THE CHARGE IN ONE-HALF OF THE ASYMMETRIC PULSE MAY BE OBTAINED SY A LARGER CURRENT FLOWING FOR A SHORTER Tit-.El AND VI-CE VERSA IN THE OTHER HALF OF THE PULSE. THE SITUATION IN THE SYMMETRIC PULSE IS SELF-EVIDENT* THE EFFICACIT'Y OF THE ALPHA DRIVE OSCILLATOR IN THE INDUCTION OF SYNERGISTIC 2 EFFECTS WHEN SYNCHRONIZED WITH THE SENSORY STIMULATORS IS A MAXIMUM WHEN THE RECTANGULAR PULSES ARE BOTH BALANCED AND SYMMETRIC. THUS IT IS ESTABLISHED THAT THE CHOICE OF BOTH THE FORM OF THE CURRENT AND THE TYPE AND POSITION OF THE ELECTRODES ARE OF PARAMOUNT IMPORTANCE IN DETERMINING THE PERFORMANCE OF THE STIMU2- LATOR. CLINICAL PRACTICE WITH ELECTROSLEEP STIMULATORS UNCOVERED A RECURRING PROBLEM7 NAMELY, THE AR O'US AL ACT ION OF AN UNEXPECTED OR U NU SU AL SO U -NO. T HAS SEEN FOUND EXPERIMENTALLY THAT WHEN A SUBJECT IS HABITUATED TO A SPECTFIC MONOTONOU2S AUDITORY STIMULUS, SUCH AS A SOUND OF CONSTANT Atic'LITUOE AND PITCH, A-NO IF THE PITCH OF THE SOUND IS DISCREETLY CHANGED BY A LARGE THE AUDI@ORY CORTEX WI'LL SE.OEMASITUA'TEO ENOUGH INCREMENTI CAUSING THE AWAKENING OF THE SusjECTI PARTICULA2RLY IF IN THE R@--ri STATE. THE PROBLEM WAS SOLVED By PLACING THE MONOTONE TRANSM:TTER IN THE STIMULATOR CA'B:Nr-T' AND TRANSMITTING THE 'SOU.'40 THROUGH TUSc'S TO SOU,%'D--fS-OLATI.NG PLASTIC CUPS HELD IN PLACE OVER THE EARS. BY THIS MEANS 5 ANY EXTERNAL SOUNDS WOU-LO 8- ATTE.@'.UATc-'D TO A LEVEL AFTER FILTERING THROUGH THE CUP WALLS WHICH IS FAR BEL-OW TH!r THRESHOLD OF AUDIBILITY CREATED BY THE %IONCTONr- ENTERING THE CAVITIES VIA RURBER TUOF-S. THE -,ONOTONE APPLICA"CR EXTENDS THE USE OF THE STIMULATOR BEYOND THE QUIET PRIVATE ROOM TO THE NOISY OFFICE ROOM OR HOSPITAL WARD. IN CONCLUSIONI AN ELECTROP HYSIOLOGICAL STIMULATOR PROVIDING THREE BALANCED, SYMMETRIC' AND SYNCHRONIZEO STIMULI - AUDITORY3 MONOTONET ELECTRICAL FLICKERI AND ALPHA DRIVE - APPLIED TO THE HEAD VIA MONOTONE EAR CAVITIES, FLICKER TEMPLE OR FOR,-HEAD ELECTRODES, AND ALPHA DRIVE OCCIPITAL ELECTRODES RE-- SPECTIVELY, CAN BRING A NEW ORDER OF EFFECTIVENESS TO R&@-M ELECTR6-THERAPY..