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Dear Mr.

I thought of you when the author of the attached report caπe in to see me the other day. As you see, he has inyented a better slèep machinc. The machine is being used by co-author

I know enough about sleep prysiology to detect some Ilagrant mistakes in the text, but am sendinε you a copy in hopes you may be able to give me an confidential evaluation. The reason I am asking yo to go to the trouble is that iis giving a. revort on use of the machine in San Francisoo 1

Do vou think the machine is a lot of hooku or may he have something?

électrcnic engineer.

/He says he is an

Thanks for, ary help you can give.
Sincerelv.

xerox Copy to for Juformztion

Iutrod to Sey Smoothig + Predictia 1969. M.c GrwHit Stet Cameo Theory Diserete fuid, entlysis Jokuw1lg

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1A 8,7,4.

Oct. 22, 1959

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THE RUSSIANS PIONEERED "SLEEP THERAPY" OVERTHIRTY YEARS AGO, AND HAVE TREATED MORE THAN 5OO,OOOPERSONS IN SOME 3OO SLEEP CLINICS LOCATED IN VARIOUSPARTS OF THEIR COUNTRY. AMERICAN SCIENTISTS HAVE BEENSKEPTICAL OF ELECTROSLEEP BECAUSE OF THE WIDE RANGE OFCONDITIONS WHICH THE RUSSIANS CLAIM TO BENEFIT. LIKE-WISE, THE RUSSIAN CHOICE OF THE NAME "ELECTROSLEEP" CRE-ATED THE IMPRESSION THAT IT WAS A MACHINE TO INOUCE NATU-RAL SLEEP BY ELECTRICAL STIMULATION, ANO THAT AN EXTRAHOUR OR TWO OF NATURAL SLEEP WAS RESPONSIBLE FOR ITS SUC-CESS. HOWEVER, THE RUSSIANS DION'T KNOW HOW OR WHY ITWORKED ON SUCH AN APPARENTLY UNRELATED GROUP OF AILMENTS,BUT SINCE IT WAS FOUNO THAT MANY OF THE OESERVABLE ANDMEASURABLE CHANGES THAT OCCUR WHEN AN INOIVIOUAL GOESFROM WAKEFULNESS TO SLEEP TOOK PLACE DURING STIMULATION,THE MAME "ELECTROSLEEP" PROBABLY SEEMEO TO THEM AS ALOGICAL CHOICE. UNFORTUNATELY, WHEN AMERICAN INVESTIGA-TORS TESTED THE ELECTROSON.SOLELY AS A SLEEP-INDUCINGMACHINE RATHER THAN A MOOALITY FOR TREATING VARIOUS AIL-MENTS AND FOUND THAT ONLY A PORTION OF THE SUBJECTS ACT-UALLY FELL ASLEEP, THEY CONSIDERED THAT THE RUSSIAN CLAIMWERE GREATLY EXAGGERATED.

一:-HOWEVER, AT LONG LAST, AMERICAN DOCTORS ARE SHOWINGINTEREST IN ELECTROSLEEP THERAPY BECAUSE OF THE LARGE AMOUNTOF AMERICAN RESEARCH ON SLEEP SINCE ABOUT ISSS. THIS

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INTEREST STEMMED FROM THE DISCOVERY OF A NEW KINO OF SLEEP AND FROM A NUMBER OF INVESTIGATIONS OF THE EFFECTS OF SLEEP DEPRIVATION. THIS NEW KIND OF SLEEP IS MOST COMMONLY CALLED REM, DREAM, OR DEEP SLEEP BECAUSE ITS MOST SALIENT FEATURES ARE RAPID EYE MOVEMENTS, DREAMING, AND EXTREME MUSCLE RELAXATION. QUIET, OR SLOW-WAVE, SLEEP IS SO NAMED BECAUSE OF THE ABSENCE OF THE OCCASIONAL BODY MOVEMENTS OF REM SLEEP ANO THE FACT THAT THE BRAIN WAVES HAVE MUCH LOWEF: FREQUENCIES.

MODERN THEORIES ON SLEEP ARE DERIVED FROM A CONSIDERABLE AMOUNT OF RESEARCH USING THE AOVANCED TECHNIQUES OF ELECTRONIC INSTRUMENTATION, AND THIS RESEARCH DISCLOSES THAT THE ONSET OF SLEEP IS A VERY COMPLEX INTEGRATION OF MANY FACTORS WHICH INVOLVE BOTH EXCITATORY ANO INHIBITORY PROCESSES. THESE THEORIES ARE FAR FROM BEING COMPLETE, BUT FOR THE PURPOSE OF THIS PAPER, AN ELEMENTARY DESCRIPTION OF PHENOMENA WHICH ARE PERTINENT TO AN EXPLANATION OF ELECTRI-CAL STIMULATION ARE PRESENTED HERE.

THE STATE OF WAKEFULNESS IS MAINTAINED BY TWO ENTIRELY DIFFERENT TYPES OF ACTIVATORY PROCESSES WHICH ARE CALLED SENSORY STIMULATION AND TONIC FACILITATION. IN SENSORY STIMULATION, THERE IS.A FLOW OF INFORMATION FROM THE SENSE ORGANS WHICH ARE LOCATED BOTH PERIPHERALLY AND INTERNALLY THROUGH THE THALAMIG NUCLEUS IN THE BRAINSTEM TO VARIOUS REGIONS IN THE BRAIN WHICH ARE SPECIFIC TO EACK TYPE OF INFORMATION. THE FLOW IS'CONTROLLED OR MODULATED BY THE SENSORY RECEPTORS, VARIOUS SYNAPSES, AND BY THE BRAINSTEM CONTROLCENTER. THESE STIMULI UNDER.CERTAIN CONDITIONS ALSO MAY INOUCE A REVERSE FLOW FROM THE CEREBRAL CORTEX TO THE BRAINSTEM CAUSING FURTHER AROUSAL ACTIVATION. THE CNSET OF SLEEP MECHANISM STARTS WITH INHIBITION IN THIS SYSTEM. VISUAL AND'AUDITORY STIMULI,MUSCLE TENSION, AND

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MOTOR ACTIVITY ALL HAVE STRONG AROUSAL ACTION WHICH ARE NORMALLY INHIBITED WHEN WE LIE DOWN AND RELAX IN A QUIET, OARK 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 HEARO, OR BY A FLASHING LIGHT REPEATED FOR A PERIOD OF 3OO TO 5OO SECONDS. A FAR SUPERIOR VISUAL STIMULUS, HOWEVER, IS THE INOUCTION OF. VISUAL 'IMAGES BY. ELECTRICAL STIMULATION OF THE OPTIC SYSTEM, SINCE THE FREQUENCY OF THE FLICKER CAN BE INCREASED BY A FACTOR OF ABOUT THREE BEFORE THE FLICKER DISAPPEARS BY FUSION. A BY-PRODUCT OF THE HABITUATION OF THE AUDITORY AND VISUAL SYSTEMS IS THE DEACTIVATION OF MUSCLE TENSION INOUCING A GENERAL RELAXATION. THIS RESULT IS CONFIRMED NOT ONLY BY THE OBSERVED MUSCLE FLACIOITY 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 STATE. THE SENSORY SYSTEM IS INACTIVE OURING SLEEP ANO IF NO STIMULATION IS PRESENT, SLEEP WILL FOLLOW. THIS PHENOMENON IS EXEMPLIFIED SY THE CASE OF A SUBJECT WHO, THROUGH INJURY, LOST THE SIGHT IN ONE EYE ANO THE HEARING IN ONE EAR, WHO WOULD FALL ASLEEP EVENTUALLY WHENEVER THE GOOD EYE AND EAR WERE COVERED AND PLUGGED RESPECTIVELY.

IN ORDER TO PREVENT UNWANTED SLEEP THE BRAIN IS PROVIDED WITH A CONTINUOUS STIMULATION WHICH ORIGINATES IN THE MESENCEPHALIC HEMISPHERE OF. THE. BRAINSTEM. THIS TONIC FACILITATION WHICH KEEPS THE BRAIN AWAKE HAS A MAXI MUM INTENSITY AFTER AWAKENING AND IT IS CONTINUOUSLY SUP-PRESSEO DURINGTHE DAY WITH A MINIMUM MAGNITUDE AT BED-TIME. THE ORIGIN OF THIS SUPPRESSION OF TONIC FACILITATION IS RELATED TO THE NEED FOR RECOVERY WHICH PROGRESSES OURING THE OAY ANO TERMINATES IN SLEEP. THE TIME FOR RECOVERY RANGES FROM MAGNITUDES MEASURED IN MILLISECONDS, SUCH AS

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THE NERVES, TO HOURS IN THE CASE OF THE HIGHEST LEVEL OF CEREBRAL ACTIVITY. THIS HIGHEST LEVEL IS FOUND TO OCCUR IN LEARNING ANO CONDITIONING WHICH IS THE REASON FOR THE LARGE AMOUNT OF TIME SPENT BY A BABY IN SLEEP. THIS ACTIVITY IS BELIEVED TO PRODUCE 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 CORRELATION BETWEEN A SPECIFIC REGION AND ITS FUNCTIONS ARE TO STIMULATE TIC RECION WITH VARIOUS CHEMICALS OR ELECTRICAL CURRENTS OF VARIOUS CHARACTERISTICS, ANO OBSERVE THE PHENOMENA PROOUCEO; ANO TO CUT OR REMOVE A SPECIFIC REGION ANO OBSERVE THE CHANGE IN PHENOMENA BEFORE AND AFTER RE-STIMULATION, SOMETIMES SUPPLEMENTED BY APPROPRIATE ELECTRONIC INSTRUMENTATION.

WHEN THE MESENCEPHALON IS REMOVED IN ANIMALS A SLEEP-LIKE STATE CHARACTERIZED BY EYE CLOSURE, MUSCLE RELAXATION, LOWEREO PULSE ANO RESPIRATION RATES, AND INSENSIBILITY TO TACTILE PRESSURE HAS BEEN  PRODUCEO. THE SAME SLEEP-LIKE STATE HAS BEEN INDUCED BY INSERTING MICRO ELECTRODES AND PASSING A LOW FREQUENTY CURRENT THROUGH THE MESENCEPHALON.

IN REVIEW, IT HAS BEEN ESTAELISHED THAT THREE STIMULI CAN PROVIDE THE CONDITIONS FCR THE ONSETOF SLEEP, NAMELY, AN AUDITORY MONOTONE FOR HABITUATING THE AUOITORY CORTEX,.AN ELECTRICAL FL.ICKER FOR HABITUATING THE VISUAL CORTEX - EITHER ONE OF WHICH WILL INDUCE A RELAXED MUSCULATURE

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ANO A LOW FREQUENCY ÉLECTRICAL CUARENT WHICH MUST PASSTHROUGH THE BRAINSTEM IN OROER TO DEACTIVATE THE MESEN-CEPHALON. HOWEVER, A NEW PROBLEM EXISTS BECAUSE TWODIFFERENT ELECTRIC CURRENTS FLOWING IN THE SAME REGIONWILL INTERFERE WITH EACH OTHER. THIS PROBLEM WAS SOLVEDBY SYNCHRONIZING THE TWO ELECTRICAL CURRENTS。 THISSYNCHRONIZATION PROOUCED AN AMAZING RESULT - THE ELECTRI-CAL FLICKER WAS TWICE AS BRIGHT IF THE LOW FREQUENCY CUR-RENT THROUGH THE BRAINSTEM WAS THE SAME AS THE ALPHARHYTHM, ANO IF THE FLICKER CURRENT FREQUENCY WAS FOURTIMES THE ALPHA FREQUENCY. THE RESULTS WERE OPTINUM WHENTHE MONOTONE WAS ALSO SYNCHRONIZED WITH THE TWO ELECTRICALSTIMULI。 THE THREE SYNCHRONIZED STIMULI - AUDITORY MONO-TONE, ALPHA DRIVE, ANO ELECTRICAL FLICKER - INDUCE A STATEOF RELAXATION, A SLEEP-LIKE STATE, OR SLEEP.

CONCERN OVER LOSS OF SLEEP BY THE ARMED FORCES OURING WAR RESULTED IN NUMEROUS STUDIES ON THE EFFECTS OF SLEEP DEPRIVATION SINCE IT HAO BEEM KNOWN FOR A LONG TIME THAT SLEEP DEPRIVATION LEADS TO MAL-FUNCTION, PERMANENT DAMAGE, ANO FINALLY DEATH; ANO ALSO THAT TEMPORARY SLEEP LOSS IS MADE UP BY INCREASEO SLEEPING TIME DURING THE RECOVERY PERIOO. THE MENTAL SYMPTOMS OF SLEEP LOSS FOLLOW A SLOW AND PREDICTABLE PATTERN, AND THE CHANGES ACCELERATE AS TIME PASSES. SOME OF THE CHANGES FOLLOWING SLEEP DEPRIVATION ARE: INATTENTION, WEARINESS, LACK OF CONCEN-TRATION, LOSS OF MEMORY, SLURRED ANO FAULTY SPEECH, LIST-LESS BEHAVIOR, REDUCED MUSCULAR EXERTION, ANXIETY SKIN SENSATIONS, WITHORAWAL FROM REALITY, TIME DISORIENTATION, VISUAL DISTORTIONS, ILLUSIONS, HALLUCINATIONS, SEVERE PERSONALIT-Y CHANGES, AND FINALLY A PSYCHOTIC STATE. THE EEG'S OF BRAIN WAVES SHOWED AN ALTERNATION BETWEEN THE ALPHA FORM AND THE SLOW SLEEP-LIKE WAVES, ANO THESE AL-TERNATIONS ARE CALLED "MICROSLEEPS".

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SLEEP IS PRECEDED BY A DECLINE IN ACTIVITIES OR PCRFORMANCE AND BY SUBJECTIVE FEELINGS OF TIREONESS, WHICH HAVE BEEN CONSIDERED TO BE DUE TO AN ACCUMULATION DURING WAKEFULNESS OF WASTE PROOUCTS WHIGH ARE DISPOSED OF OURING SLEEP OR OF A DEPLETION DURING WAKFEULNESS CF VITAL CHEMICALS WHICH ARE REPLENISHED OURING SLEEP. WHEN CEREBROSPINAL 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 "HORMONE"-LIKE SUBSTANCE EXHIBITING A WIDE RANGE OF POWERFUL EFFECTS ON THE BRAIN AND OTHER ORGANS OF THE BOOY, IS FOUND IN CEREBROSPINAL FLUID. SIMILAR EXPERIMENTS WITH WATER-SOLUBLE EXTRACTS FROM THE BRAINS OF SLEEPING ANIMALS PROOUCED SLEEP IN THE RECIPIENT ANIMALS. THE MEDULLA AT THE BASE OF THE BRAINSTEM CONTAINS THE RAPHE NUCLEI WHICH ARE NOTED FOR THEIR PRODUCTION OF SEROTONIN. WHEN 8O% OF THE CELLS OF THESE NUCLEI ARE DESTROYED THE EXPERIMENTAL ANIMALS SLEPT LESS THAN IO% OF THEIR NORMAL PERIOD. SIMILARLY, THERE IS A LOCUS COERULEUS NUCLEUS JUST BELOW THE RAPHE NUCLEI WHICH CONTAINS THE SYSTEM FOR PRODUCING REM SLEEP, AND.THIS NUCLEUS USES NORAORENALIN FOR ITS ACTIVATING AGENT.

IT HAS BEEN LONG SUSPECTED THAT THERE 'IS A STRONG LINK BETWEEN INSOMNIA AND MENTAL ILLNESSO IN ONE TWO-YEAR SURVEY OF SEVERAL HUNDRED MENTAL PATIENTS (WITH PSYCHOSES, DEPRESSIONS, AND OTHER AILMENTS), IT WAS FOUND THAT SI% OF THEM HAD BEEN SUFFERING FROM SLEEP DISORDERS, AND'MANY OF THEM WERE COGNIZANT THAT SLEEP LOSS WAS'THE CAUSE OF THEIR.AILMENT. IN ANOTHER STUOY OF A L'ARGE NUMBER OF PATIENTS HAVINC HEART SURCERY, IT WAS FOUND THAT A HOSPITAL IS NO PLACE TO FIND REST. PATIENTS'COMPLAINED BITTERLY OF LACK OF SLEEP IN A BUSY WARD WITH HOURLY·MEOICAL CHECKS AND

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EXTENDED NURSING CARE. THIS STUDY DISCLOSED THE FACT THAT IN A THRCC TO FIVE DAY POST-OPERATIVE PERIOD, OVER ONE-THIRD OR TUC PATIRNTO HAD DIVILOPED PARANOID SUSPICIONS, DLI IRIUM,DISORILNIAIIUN,AND HALLUCINATIONS WHICH VANISHCO AITIR THL PATICNI WAS PLACED IN A QUICT ROOM WITH A MINIMUM NUMOCR OP INTERRUPTIONS. THESE AND OTHCR STUOICS URING LOSS OR SLCEP INTO FOCUS AS AN IMPORTANT FACTOR IN MEDICAL PRACTICC SINCE THE SLCEP OCPRIVATIGN STUDIES SHOWED THAT THE SYMPTOMS APPEARING WERE ESSENTIALLY THE SAME AS FOUND IN THE MENTALLY ILL. THE IMPORTANT QUESTION IS, THEREFORE, WHICH KINO OF SLEEP LOSS IS THE CULPRIT.

SEVERAL STUOIES OF REM SLEEP DEPRIVATION WERE MADE AFTER OVERCOMING THE DIFFICULTIES OF DETERMINING THE EXACT TIME THAT REM DREAMING STARTED AND ENDED. WHEN AN INDIVIOUAL'GOES TO SLEEP, HIS INITIAL QUIET SLOW-WAVE SLEEP LASTS FOR A PERIOD OF 6O TO 90 MINUTES AFTER WHICH HE STARTS DREAMING. THERE ARE NORMALLY FOUR OR FIVE OF THESE REM PERIOOS, IN WHICH THE FIRST ONE IS THE SHORTEST AND THE LAST ONE IS THE LONGEST, ANO ONLY THE DRCAMS OF THE LAST ONE ARE REMEMBERED. THE TOTAL REM SLEEPING TIME IS, ON THE AVERAGE, 2O% OF THE TOTAL PERIOD. THESE STUOIES DISCLOSED THE AMAŻING FACT THAT THE LOSS OF REM SLEEP PRODUCED ESSENTIALLY THE SAME MAL-FUNCTIONING THAT OCCURRED WITH TOTAL SLEEP DEPRIVATION. THE SUBJECTS ACTUALLYSLEPT MUCH LONGER THAN USUAL IN THE QUIET SLOW-WAVE PHASES AND THEY WERE EXTREMELY DIFFICULT TO AWAKEN. THE DISCOVERY OF THIS BASIC PHENOMENON PROVIDES THE SCIENTIST WITH A NEW TOOL FOR ATTACKING SLEEP DISORDERS AND THEIR DERIVATIVE. AILMENTS. THIS THIRD STATE OF CONSCIOUSNESS CAN BE IDENTIFIED BY ITS SALIENT CHARACTERISTICS SUCH AS AN EEG PATTERN RESEMBLING THAT OF WAKEFULNESS, RAPID EYE MOVEMENTS, OFTEN JERKING OF THE' LIMBS, MARKED FLACIDITY OF NECK MUSCLES, AND ALMOST ALWAYS A REPORT OF OREAMINS WHEN AWAKENED.

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ANOTHER IMPORTANT FACET OF TOTAL SLEEP DEPRIVATION IS THAT THERE IS A CHANGE IN QUALITY OF SLEEP, ANO THIS CHANGE IS FOR THE WORST SINCE THERE IS A LARGER PERCENTAGE LOSS OF THE REM STATE.

SLEEPING PILLS AND TRANQUILIZERS ARE USED IN LARGE QUANTITIES FOR THEIR HYPNOGENIC EFFECTS, AND, SINCE THERE ARE TWO KINDS OF SLEEP, INVESTIGATIONS WERE CONDUCTED ON THE KIND OF SLEEP WHICH THEY INDUCED. THE SURPRISING RESULTS WERE THAT BARBITURATES, TRANQUILIZERS, AMPHETAMINES AND ALCOHOL SUPPRESS' THE REM STATE WHEN TAKEN REGULARLY.

WHEN REM SLEEP DEPRIVATION IS TERMINATED THERE IS A REBCUND IN THE RECOVERY PERIOD. IN WHICH THE SUBJECT SLEEPS FROM II TO I4 HOURS AFTER SEVERAL NIGHTS OF SLEEP LOSS WITH A MUCH HIGHER THAN NORMAL PROPORTION OF REM SLEEP. WITH LONGER PERIOOS OF DEPRIVATION THE PROPORTION OF REM IN CREASED. ANIMAL STUDIES OETERMINED THAT AFTER REM SLEEP OCPRIVATION THEY SECMED TO RECOVER ADOUT EO% OF THEIR LOST DREAM PERIOUS. FURTUCR STUDIES WERE MADE ON THI RECOVERY PLRIUD PHENOMENON UOING TWO CROUPS OF RATE DEPRIVCD OI SLCEP FUR POUR OR PIVE DAYS WHERE ONE CROUP WAS CIVEN A SLICHT ELLCTRIC SHOCK OY TOUCHING THE CLECTRODE TO THE EAR.. THE UNSHOCKED CONTROL GROUP SHOWEO THE USUAL INCREMENTAL COMPEN-SATORY PERIOD OF REM SLEEP BUT THE SHOCKED GROUP SPENT AMUCH SMALLER PERIOO IN REM SLEEP. THIS KEY EXPERIMENT PROVIDES A NEW METHOD OF QUICKLY REMOVING REM SLEEP DEPRIVATION EFFECTS IN THE RAT WHICH WAS SUBSEQUENTLY VERIFIED'IN THE CAT- NAMELY, B.Y PASSING AN ELECTRICAL CURRENT THROUGH THE-HEADS OF THESE ANIMALS. THIS EXPERIMENT SUGGESTS THAT THE ELECTRIC CURRENT CAUSES THE RELEASE OF A COMPOUND THAT COULD BLOCK THE F-OW OF THE ACTIVATING AGENT 'FOR REM SLEEP, WHICH HAS BEEN IOENTIFIEO AS NORADRENALIN.IT HAS BEEN KNOWN FOR

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SDMETIME THAT THE PONTINE RETICULAR FORMATION CONTAINSA TIMING DEVICE WHICH PRODUCES REM SLEEP AT REGULAR.INTERVALS BUT WHICH IS INTERRUPTEO DURING WAKEFULNESS.IT HAS BEEN OETERMINED EXPERIMENTALLY THAT A SPECIFICDOSE OF RESERPINE IN CATS LEADS TO A COMPLETE ELIMINATIONOF REM SLEEP FOR AS LONG AS FOUR DAYS. A POSSIBLEHYPOTHESIS IS, THEREFORE, THAT THE ELECTRIC CURRENTCOUNTERACTED.THE BLOCKING EFFECT OF A RESERPINE-LIKESUBSTANCE OF EITHER THE TIMING DEVICE OR OF THE EXCRE-TION OF NORADRENALIN FROM THE LOCUS COERULEUS REGION.IF THE CAUOAL PONTINE RETICULAR FORMATION IS CUT ORREMOVED, REM SLEEP IS COMPLETELY ELIMINATED, CUT IFTHIS REGION IS STIMULATEO ELECTRICALLY WHILE MAN ISIN A SLOW SLEEP-LIKE STATE, REM SLEEP WILL FOLLOW. ITIS POSSIBLE FOR STRONG AROUSAL STIMULI OR DRUGS, SUCHAS AMPHETAMINE, TO COUNTERACT THIS ELECTRICAL STIMULA-TION. THUS, WE FIND THAT'ELECTRICAL STIMULATION OF THEBRAINSTEM AFTER SENSORY HABITUATIDN LEADS TO A QUIETSLEEP-STATE FOLLOWED BY THE REM STATE IN WHICH SYMPTOMSOF REM SLEEP DEPRIVATION ARE REVERSED. THESE CHANGESARE DRAMATIC IN A LARGE NUMBER OF CASES FOR IN MANYINSTANCES A SINGLE ONE-HOUR STIMULATION COMPLETELYREVERSES THE SYMTOLOGY OF DEPRESSION AND OTHER SIMILARBEING.

THC CLINICAL APPLICATION OF ELECTNICAL STIMULATION TO MAN INTROUUCES THE PROULEM OF PASSING AN CLECTRICAL CUR-RENT THROUGH THE HEAD, BY MEANS OF EXTERNALLY ATTACHEO ELECTRODES \_INSTEAD OF THE USE OF INTRA-SKULL MICRO-ELECTRODES PLACED IN A SPECIFIC REGION OF THE BRAINSTEM. 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

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THRJUGH ALL REGIONS OF THE RETICULAR FORMATION IF IT PASSEO THROUGH THE BRAINSTEM AT ALL.

ACCOROING TO OSCILLATOR THEORY, THE IMPEDANCE TO CURRENT FLOW IS A MINIMUM FOR FREQUENCIES APPROXIMATING THE SPONTANEOUS RHYTHMS, AND THE RHYTHMS WHICH ARE FOUNO IN THE REGIONS IMPLICATED IN THE INDUCTION OF SLEEP HAVE FREQUENCIES WHICH RANGE FROM LESS THAN I CYCLE/SEC. TO ABOUT I4 CYCLES/SEC. FOR EXAMPLE, THE WAVES IN THE PONTINE RETICULAR FORMATION DURING REM SLEEP ARE 6 TO 8 CYCLES/SEC. AND THE WAVES,FOR DROWSINESS ARE 8 TO 12 CYCLES/SEC.WHICH ARE ESSENTIALLY THE ALPHA RHYTHM. HOWEVER, THE MOST EFFECTIVE ELECTRICAL FLICKCR FREQUENCY IS 32 TO 4O CYCLES/SEC. WHICH IS.THE THIRO HARMONIC OF THE ALPHA RHYTHM, ANO THEREFORE WILL PROVIDE MINIMAL STIMULATION OF STRUCTURES WITH SPONTANEOUS FREQUENCIES OF 8 TO IO CYCLES/SEC. THUS, WE FINO THAT FOR OPTIMUM STIMU LATION OF THE OPTIC NERVE AND THE BRAINSTEM RETICULAR FOR-MATION, TWO OSCILLATORS ARE REQUIRED WITH A 4:1 FREQUENCY RATIO.

THERE ARE THREE LOW IMPEDANCE PATHS IN THEHEAD: JUST UNDER THE SCALP, THROUGH THE SURFACE AT THEBASE OF THE BRAIN, ANO ALONG THE OPTIC NERVE WHICH EX-TENDS FROM THE EYES TO THE VISUAL CORTEX. ELECTRICALFLICKER CAN BE INDUCED WITH MINIMAL CURRENT INTENSITYWITH ELECTRODES ON THE MASTOIDS BEHIND THE EARS WITHCORRESPONDING ELECTRODES OVER THE EYES, BUT THIS ARRANGE-MENT PRODUCES PSYCHOLOGICAL EFFECTS, SUCH AS ANXIETY ASWELL AS THE SIOE EFFECTS.OF EXELTO-QURNS, BLURRED VISIONIN SOME PALIENIS,INFREQUENT LARYNGEAL SPASMS,JIN ADOITIONTO MINIMAL CURRENT IN THE BRAINSTEM. FOR MAXIMUMCURRENT IN THE BRAINSTEM, THE CURRENT SHOULD FLOWEITHER BETWEEN THE TWO MASTOIDS OR FROM AN ELECTRODE AT

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THE BACK OF THE HEAD AT THE BASE OF THE OCCIPITAL LOBE TO FOREHEAO· OR TEMPLE ELECTRODES. THE LATTER ARRANGEMENT IS SUPERIOR BUT IT INTRODUCED À 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 HIPPIES, TO THE SCALP. THE IDEAL FLICKER ELECTRODE ARRANGEMENT IS EITHER WITH TEMPLE OR FOREHEAD ELECTROOES, JUST OVER THE EYES.

SUMMARIZING THE PHENOMENOLOGY, WE FIND THAT. SLEEP DISORDERS ARE THEGENESIS FOR A MAJOR PORTION OF MENTAL ILLNESS AND THAT REM-STATE SUPPRESSION IS THE ACTIVATING AGENT, AND THAT MOST OF THE DRUGS FOR TREATING MENTAL ILLNESS NOT ONLY OO NOT HAVE MUCH CURATIVE VALUE BUT ARE THEMSELVES A PARTIAL CAUSE OF THE CONDITIONS WHICK THEY ARE SUPPOSED TO TREAT. APPROPRIATE ELECTRICAL STIMULATION APPEARS TO PROVIDE THE BEST SOLUTION BECAUSE IT HAS NO SIDE EFFECTS, SUPPRESSES DRUG WITHDRAWAL REBOUND ANO PROOUCES IMMEDIATE RELIEF OF SYMPTOMS IN A SUBSTANTIAL PROPORTION OF THE MENTALLY ILL.

LOOKING AT THE CLINICAL APPLIGATIONS OF REM ELECTRO-THERAPY, A GUIOING PRINCIPLE FOR PROGNOSTICATING. ITS PROBABLE EFFICACY IN TREATING VARIOUS AILMENTS WOULD BE'TO LOOK FOR CORRELATIONS BETWEEN THE REM DEPRIVATION PHENOMENA AND THE SYMPTOLOGY OF VARIOUS AILMENTS TEMPERED BY .THE KNOWLEDGE THAT THE MODUS OPERANDI OF REM ELECTRO-THERAPY INCLUDES: RAPID DISSIPATION OF REM HYPNOTOXINS, REHABILITATION DURING REM SLEEP, AND THE SUGGESTISILITY OF THE APPARATUS PER SE. THIS SUGGESTIBILITY MAY BE EITMER FACILITATIVE OR COUNTERACTIVE DEPENDING ON THE THOUGHTS WHICH WILL BE BROUGHT INTO CONSCIOUSNESS BY ASSOCIATION WITH THE STORED MEMORIES OF PAST EXPERIENCE. FOR EXAMPLE, -11-

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THE PATIENT REACTION TO THE APPARATUS HAS BEEN ICO% COUNTERACTIVE IN ALL CASES OF PATIENTS WHO HAVE PRE-VIOUSLY BEEN GIVEN ELECTRO-CONVULSIVE SHOCK TREATMENTS. ANOTHER EXAMPLE WHICH PROVIDES A QUANTITATIVE RESULT IS. OSTAINED FROM A CLINICAL PRACTICE ANALYSIS OF ONE THOU-SANC PATIENTS IN 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 FOUNO THAT 26.7% OF THEM SHOWED NO CHANGE OR RESPONSE DURING OR AFTER TREATMENT, BUT NEARLY ALL BECAME OROWSY OR SLEPT AFTER RESTIMULATION WHICH FOL-LOWED THE ADMINISTRATION OF' A MILO SLEEPING ORUG 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-STASE SLEEP AFTER THE ELECTRODES WERE ATTACHED BUT BEFORE THE CURRENT WAS TURNEI ON.

AN EXAMINATION OF ELECTROSLEEP CASE HISTORIESREVEALS THE CONCLUSION THAT THE MAJORITY QF THE AILMENTSTREATED COULD BE DIVIDED INTO TWO DOMAINS - THE REM STATEAND THE NEUROGENIC DOMAINS, WHEREIN THE FIRST INCLUDESALL CASES IN WHICH THE SYMPTOLOGY IS RELATED TO REM OE-PRIVATION PHENOMENA, AND THESECOND INCLUDES THOSE ILL-.NESSES WHEREIN REM ELECTRC-THERAPY WOULO ONLY CONTRIBUTENEUROGENICALLY TO THE RELIEF OF SYMPTOMS 'RESPECTIVELY.THE REM STATE DOMAIN WOULD OBVIOUSLY INCLUDE INSOMNIA,DEPRESSION, SCHIZOPHRENIA, ETC.WHEREAS THE NEURCGENICDOMAIN WOULD INCLUDE DERMATITIS, ULCERS, HYPERTENSION, ETCWHEREIN PHYSIOLOGICAL CHANGES MIGHT ALSO BE IMPORTANTCAUSAL FACTORS- A QUANTITATIVE EXAMPLE OF THE NEURCGENICDOMAIN IS GIVEN BY THE RUSSIAN STUDY OF 376 PATIENTSSUFFERING FROM ARTERIAL CONGESTION IN WHICH ELECTROSLEEP

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THE MARGINAL BRAINSTEM STIMULATION OBTAINED WITH THESE GENERATORS ARE THAT THE EYES CAN ONLY TOLERATE A VERY SMALL CURRENT AND THAT ONLY SMALL CURRENTS SHOULD BE USED FOR MINIMAL IRREVERSIBLE BRAIN TISSUE CHANGES. THERE ARE TWO KINDS OF BALANCED' PULSES - SYMMETRIC AND ASYMMETRIC WHEREIN THE CHARGE IN ONE-HALF OF THE ASYMMETRIC PULSE MAY BE OBTAINED BY A LARGER CURRENT FLOWING FOR A SHORTER TIME, AND VICE VERSA IN THE OTHER HALF OF THE PULSE. THE SITUATION IN THE SYMMETRIC PULSE IS SELF-EVIDENT. THE EFFICACITY OF THE ALPHA ORIVE OSCILLATOR IN THE INDUCTION OF SYNERGISTIC EFFECTS WHEN SYNCHRONIZED WITH THE SENSORY STIMULATORS IS A MAXIMUM WHEN THE RECTANGULAR PULSES ARE BOTH BALANCED ANO SYMMETRIC. THUS IT IS ESTABLISHED THAT THE CHOICE OF BOTH THE FORM OF THE CURRENT ANO THE TYPE ANO POSITION OF THE ELECTRODES ARE OF PARAMOUNT IMPORTANCE IN OETERMINING THE PERFORMANCE OF THE STIMU-LATOR.

CLINICAL PRACTICE WITH ELECTROSLEEP 1 1 STIMULATORS UNCOVERED A RECURRING PROBLEM, NAMELY, THE … ARDUSAL ACTION OF AN UNEXPECTEO OR UNUSUAL SOUND. IT HAS SEEN FOUNO EXPERIMENTALLY THAT WMEN A SUEJECT IS HABITUATED TO A SPECIFIC MONOTONOUS AUOITORY STIMULUS, SUCH AS A SOUND OF CONSTANT AMPLITUDE AND PITCH, AND IF THE PITCH OF THE SOUND IS DISCREETLY CHANGED BY A LARGE ENOUGH INCREMENT, THE AUDITORY CORTEX WILL BE DEMASITUATED CAUSING THE AWAKENING OF THE SUBJECT, PARTICULARLY'IF IN THE REM STATE. THE PROBLEM WAS SOLVED BY PLACING THE MONOTONE TRANSMITTER IN THE STIMULATOR CABINET AND TRANSMITTING THE SOUND THROUGH TUEES TO SOUND-TSOLATING PLASTIC CUPS HELO IN PLACE OVER THE EARS. BY THIS MEANS ANY EXTERNAL SOUNOS WOULD BE ATTENUATED TO A LEVEL AFTER FILTERING THROUGH THE CUP WALLS WHICH IS FAR BELOW THE THRESHOLD OF AUOIBILITY CREATED BY THE MONOTONE ENTERING

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THE CAVITIES VIA RUGBER TUBES. THE MONOTONE APPLICATCR EXTENOS THE USE OF THE STIMULATOR BEYOND THE QUIET PRIVATE ROOM TO THE NOISY OFFICE ROOM OR HOSPITAL WARO.

IN CONCLUSION, AN ELECTRQPHYSIOLOCICAL STIMULATOR PROVIDING THREE BALANCED, SYMMETRIC AND SYNCHRONIZED STIMULI - AUDITORY MONOTONE, ELECTRICAL FLICKER, ANO ALPHA DRIVE - APPLIED TO THE HEAD VIA MONOTONE EAR CAVITIES, FLICKER TEMPLE OR FOREHEAD ELECTRODES, ANO ALPHA DRIVE OCCIPITAL ELECTRODES RE-SPECTIVELY, CAN BRING A NEW ORDER OF EFFECTIVENESS TO REM ELECTRO-THERAPY: 1

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