[PAGE 1]
8,1,01

Dear Mr.

I thought of you when the author of tha attached report came in to see me the other day. As you see, he has inyented a better sleep machine. The\_machine is being-used by co-author

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

Do you think the machine is a lot of hookum ormay he have something?

éelectronic engineer.

\_{He says he is an

Thanks for, any help you can give.
Sincerelv.

xerox Copy to for Juformztion

Oct. 22, 1969

[PAGE 2]
THE RUSSIANS PIONEERED "SLEEP THERAPY" OVERTHIRTY YEARS AGO, ANO HAVE TREATED MORE THAN 5OO,OOOPERSONS IN SOME 3OO SLEEP CLINICS LOCATED IN VARIOUSPARTS OF THEIR COUNTRY. AMERICAN SCIENTISTS HAVE SEENSKEPTICAL 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 INDUCE NATU-RAL SLEEP BY ELECTRICAL STIMULATION, AND THAT AN EXTRAHOUR OR TWO OF NATURAL SLEEP WAS RESPCNSIBLE FOR ITS SUC-CESS. HOWEVER, THE RUSSIANS OIDN'T KNOW HOW OR WHY ITWORKED ON SUCH AN APPARENTLY UNRELATED GROUP OF AILMENTS,BUT SINCE IT WAS FOUND THAT MANY OF THE OBSERVABLE ANDMEASURABLE CHANGES THAT OCCUR WHEN AN INDIVIDUAL GOESFROM WAKEFULNESS TO SLEEP TOOK PLACE OURING STIMULATION,THE NAME "ELECTROSLEEP" PROBABLY SEEMED TO THEM AS ALOGICAL CHOICE. UNFORTUNATELY, WHEN AMERICAN INVESTIGA-TORS TESTED THE ELECTROSON SOLELY AS A SLEEP-INDUCINGMACHINE RATHER THAN A MODALITY FOR TREATING VARIOUS AIL-MENTS AND FOUND THAT ONLY A PORTION OF THE SUBJECTS ACT-UALLY FELL ASLEEP, THEY CONSIDERED THAT THE RUSSIAN CLAIMSWERE GREATLY EXAGGERATED.

HOWEVER, AT LONG LAST, AMERICAN DOCTORS ARE SHOWING INTEREST IN ELECTROSLEEP THERAPY BECAUSE OF THE LARGE AMOUNT OF AMERICAN RESEARCH ON SLEEP SINCE ABOUT I95S. THIS

REM ELECTRO-THERAPY

[PAGE 3]
INTEREST STEMMED FROM THE OISCOVEAY OF A NEW KIND 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 LOWER FREQUENCIES.

MODERN THEORIES ON SLEEP ARE DERIVED FROM A CONSLDERABLE AMOUNT OF RESEARCH USING THE ADVANCED 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 AND 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 THALAMIC NUCLEUS 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 CONTROLCENTER. THESE STIMULI UNDERCERTAIN CONOITIONS ALSO MAY INDUCE A REVERSE FLOW FROM THE CEREBRAL CORTEX TO THE BRAINSTEM CAUSING FURTHER AROUSAL ACTIVATION. THE ONSET OF SLEEP MECHANISM STARTS WITH INHIBITION IN THIS SYSTEM. VISUAL AND AUDITORY STIMULI,MUSCLE TENSION, AND

[PAGE 4]
MOTOR ACTIVITY ALL HAVE STRONG AROUSAL ACTION WHICH ARE NORMALLY INHIBITED WHEN WE LIE DOWN AND RELAX IN A QUIET, 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 FOR A PERIOO OF 3OO TO 5OO SECONDS. A FAR SUPERIOR VISUAL STIMULUS, KOWEVER, 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-PROOUCT OF THE HABITUATION OF THE AUDITORY AND VISUAL SYSTEMS IS THE DEACTIVATION OF MUSCLE TENSION INDUCING A GENERAL RELAXATION. 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 STATE. THE SENSORY SYSTEM IS INACTIVE DURING 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 AND 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-PRESSED DURING-THE DAY WITH A MINIMUM MAGNITUDEAT BED-TIME. THE ORIGIN OF THIS SUPPRESSION OF TONIC FACILITATION IS RELATED TO THE NEED FOR RECOVERY WHICH PROGRESSES OURING THE DAY AND TERMINATES IN SLEEP. THE TIME FOR RECOVERY RANGES FROM MAGNITUDES MEASURED IN MILLISECONDS, SUCH AS

7

[PAGE 5]
THE NERVES, TO HOURS IN THE CASE OF THE HIGHEST LEVEL GF CEREORAL 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 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 FINDINGA CORRELATION BETWEEN A SPECIFIC REGION AND ITS FUNCTIONSARE TO STIMULATC TIC RCCION WITII VARIOUS CHEMICALS ORELECTRICAL CURRENTS OF VARIOUS CHARACTERISTICS, AND OBSERVETHE PHENOMENA PRGDUCEO; AND TO CUT OR REMOVE A SPECIFICREGION AND OBSERVE THE CHANGE IN PHENOMENA BEFORE ANDAFTER RE-STIMULATION, SOMETIMES SUPPLEMENTED BY APPROPRIATEELECTRONIC INSTRUMENTATION.

WHEN THE MESENCEPHALON IS REMOVED IN ANIMALS A SLEEP-LIKE STATE CHARACTERIZED BY EYE CLOSURE, MUSCLE RELAXATION, LOWERED PULSE AND RESPIRATION RATES, AND INSENSISILITY TO TACTILE PRESSURE HAS BEEN PRODUCED. 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 ESTABLISHED THAT THREE STIMULI CAN PROVIDE THE CONDITIONS FOR THE CNSET OF SLEEP, NAMELY, AN AUDITORY MONOTONE FOR HASITUATING THE AUDITORY CORTEX,.AN ELECTRICAL FL.ICKER FOR HABITUATING THE VISUAL CORTEX - EITHER ONE OF WHICH WILL INOUCE A RELAXED MUSCULATURE

4.

[PAGE 6]
AND A LOW FREQUENCY ÉLECTRICAL CURRENT WHICH MUST PASSTHROUGH THE BRAINSTEM IN ORDER 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 PRODUCED 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, AND 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, AND ELECTRICAL FLICKER - INDUCE A STATEOF RELAXATION, A SLEEP-LIKE STATE, OR SLEEP.

CONCERN OVER LOSS OF SLEEP BY THE ARMEO FORCES OURING WAR RESULTED IN NUMEROUS STUDIES ON THE EFFECTS OF SLEEP DEPRIVATION SINCE IT HAD BEEN KNOWN FOR A LONG TIME THAT SLEEP DEPRIVATION LEADS TO MAL-FUNCTION, PERMANENT DAMAGE, AND FINALLY DEATH; AND ALSO THAT TEMPORARY SLEEP LOSS IS MADE UP BY INCREASED SLEEPING TIME DURING THE RECOVERY PERIOD. THE MENTAL SYMPTOMS OF SLEEP LOSS FOLLOW A SLOW AND PREDICTASLE 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 AND FAULTY SPEECH, LIST-LESS BEHAVIOR, REDUCED MUSCULAR EXERTION, ANXIETY, SKIN SENSATIONS, WITHDRAWAL 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, AND THESE AL-TERNATIONS ARE CALLED "MICROSLEEPS".

.5.

[PAGE 7]
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 OURING WAKEFULNESS OF WASTE PRODUCTS WHICH ARE OISPOSED OF OURING SLEEP OR OF A DEPLETION DURING WAKFEULNESS OF VITAL CHEMICALS WHICH ARE REPLENISHED DURING SLEEP. WHEN CEREBROSPINAL FLUID FROM FATIGUEO 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 EXPERIMENT: WITH WATER-SOLUBLE EXTRACTS FROM THE BRAINS OF SLEEPING ANIMALS PRODUCED 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 DESTRCYED THE EXPERIMENTAL ANIMALS SLEPT LESS THAN IO% OF THEIR NORMAL PERIOO. SIMILARLY, THERE IS A LOCUS COERULEUS NUCLEUS JUST BELOW THE RAPHE NUCLEI WHICH CONTAINS THE SYSTEM FOR PROOUCING REM SLEEP, AND.THIS NUCLEUS USES NORADRENALIN FOR ITS ACTIVATING AGENT.

IT HAS BEEN LONG SUSPECTED THAT THERE IS A STRONG LINK BETWEEN INSOMNIA AND MENTAL ILLNESS 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, ANO'MANY OF THEM WERE COGNIZANT THAT SLEEP LOSS WAS THE CAUSE OF THEIR AILMENT. IN ANOTHER STUDY OF A LARGE NUMBER OF PATIENTS HAVING HEART SURGERY, IT WAS FOUND THAT A HOSPITAL IS NO PLACE TO FIND REST. PATIENTSCOMPLAINED BITTERLY OF LACK OF SLEEP IN A BUSY WARD WITH HOURLY-MEOICAL CHECKS AND

-6-

[PAGE 8]
EXTENDED NURSING CARE. THIS STUDY DISCLOSED THE FACT THAT IN A THREE TO FIVE DAY POST-OPCRATIVE PEHIOD, OVCR ONE-TuIRDor TUE PATILNTS HAD DIVELOPED PARANOID SUSPICIONS, OLIIRIUN, DISORILNIAIION, ANO HALLUCINATIONG WHICH VANISHCO AIIIR TI PATIENT WAS PLAGID IN A QUICT ROOM WITH A MINIMUM NUMICR OI INTCRRUPTIONS. THESE AND OTHCR STUDIES URING LOSS OF SLEEP INTO FOCUS AS AN IMPORTANT FACTOR IN MEOICAL PRACTICE SINCE TBE SLCEP DEPRIVATIGN STUDIES SHOWED THAT THE SYMPTOMS APPEARING WERE ESSENTIALLY THE SAME AS FOUND IN THE MENTALLY ILL. THE IMPORTANT QUESTION IS, THEREFORE, WHICH KIND OF SLEEP LOSS IS THE CULPRIT.

SEVERAL STUDIES OF REM SLEEP DEPRIVATION WERE MADE AFTER OVERCOMING THE DIFFICULTIES OF DETERMINING THE EXACT TIME THAT REM OREAMING STARTED AND ENDED. WHEN AN INDIVIDUAL GOES TO SLEEP, HIS INITIAL QUIET SLOW-WAVE SLEEP LASTS FOR A PERIOD OF 6O TO 9O MINUTES AFTER WHICH HE STARTS DREAMING. THERE ARE NORMALLY FOUR OR FIVE OF THESE REM PERIODS, IN WHICH THE FIRST ONE IS THE SHORTEST ANO THE LAST ONE IS THE LONGEST, AND ONLY THE DREAMS OF THE LAST ONE ARE REMEMBERED. THE TOTAL REM SLEEPING TIME IS, ON THE AVERAGE, 2O% OF THE TOTAL PERIOD. THESE STUDIES DISCLOSED THE AMAŻING FACT THAT THE LOSS OF REM SLEEP PRODUCED ESSENTIALLY THE SAME MAL-FUNCTIONING TMAT OCCURRED WITH TOTAL SLEEP DEPRIVATION. THE SUBJECTS ACTUALLY SLEPT 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 DREAMING WHEN AWAKENED.

.7.

[PAGE 9]
ANOTHER IMPORTANT FACET OF TOTAL SLEEP DEPRIVATION IS THAT THERE IS A CHANGE IN QUALITY OF SLEEP, AND 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 KINOS OF SLEEP, INVESTIGATIONS WERE CONDUCTED ON THE KIND OF SLEEP WHICH THEY INDUCED. THE SURPRISING RESULTS WERE THAT BARBITURATES, TRANQUIEIZERS, AMPHETAMINES AND ALCOHOL SUPPRESS THE REM STATE·WHEN TAKEN REGULARLY.

WHEN REM SLEEP DEPRIVATION IS TERMINATED THERE IS A REBOUND 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 DETERMINED THAT AFTER REM SLEEP DEPRIVATION THEY SEEMED TO RECOVER ABOUT GO% OF THEIR LOST DREAM PLRIOUS. FUNTUCR STUDIES WERE MAOE ON THL RECOVCRY PLRIOD PHENOMCNON USING TWO GROUPS OF RATS OEPRIVED OI SLCEP FOR FOUR OR PIVE DAYS WHENE ONE CROUP WAS GIVEN A SLICHT ELLCTRIC SHOCK BY TOUCHING THE ELECTRODE TO THE EAR. THE UNSHOCKED CONTROL GROUP SHOWEO THE USUAL INCREMENTAL COMPEN SATORY PERIOO OF REM SLEEP BUT THE SHOCKED GROUP SPENT AMUCH SMALLER PERIOD 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 FLOW OF THE ACTIVATING AGENT FOR REM SLEEP, WHICH HXS BEEN IDENTIFIED AS NORADRENALIN.IT HAS BEEN KNOWN FOR

.8.

[PAGE 10]
SOMETIME THAT THE PONTINE RETICULAR FORMATION CONTAINSA TIMING DEVICE WHICH PRODUCES REM SLEEP AT REGULAR.INTERVALS BUT WHICH IS INTERRUPTED OURING WAKEFULNESS.IT HAS BEEN DETERMINED 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 CAUDAL PONTINE RETICULAR FORMATION IS CUT ORREMOVED, REM SLEEP IS COMPLETELY ELIMINATED, BUT IFTHIS REGION IS STIMULATED 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 HABITUATION 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 OP CLECTRICAL STIMULATION TO MAN INTRODUCES THE PROULEM OF PASSING AN ELECTRICAL CUR-RENT THROUGH THE HEAD, BY MEANS OF EXTERNALLY ATTACHED ELECTRODES \_INSTEAD OF THE USE OF INTRA-SKULL MICRO-ELECTRODES PLACEO 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 OSVIOUS THAT AN ELECTRICAL CURRENT FROM EXTERNAL ELECTRODES WOULD PASS

[PAGE 11]
THROUGH ALL REGIONS OF THE RETICULAR FORMATION IF IT PASSED THROUGH THE BRAINSTEM AT ALL.

ACCORDING TO OSCILLATOR THEORY, THE IMPEDANCE TO CURRENT FLOW IS A MINIMUM FOR FREQUENCIES APPROXIMATING THE SPONTANEOUS RHYTHMS, AND THE RHYTHMS WHICH ARE FOUND IN THE REGIONS IMPLICATED IN THE INDUCTION OF SLEEP HAVE FREQUENCIES WHICH RANGE FROM LESS THAN I CYCLE/SEC. TO AUOUT I4 CYCLES/SEC. FOR EXAMPLE, THE WAVES IN THE PONTINE RETICULAR FORMATION DURING REM SLEEP ARE 6 TO E CYCLES/SEC., AND THE WAVES.FOR DROWSINESS ARE 8 TO I2 CYCLES/SEC.WHICH ARE ESSENTIALLY THE ALPHA RHYTHM. HOWEVER, THE MOST EFFECTIVE ELECTRIGAL FLICKER FREQUENCY IS 32 TO 4O CYCLES/SEC. WHICH IS.THE THIRD HARMONIC OF THE ALPHA RHYTHM, AND THEREFORE WILL PROVIDE MINIMAL STIMULATION OF STRUCTURES WITH SPONTANEOUS FREQUENCIES OF 8 TO IO CYCLES/SEC. THUS, WE FIND 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, AND 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 SIDE EFFECTS OF EXELTDBURNS BLURRED VISIONIN SOME PALIENIS,INFREQUENT LARYNGEAL SPASMS,IN ADDITIONTO MINIMAL CURRENT IN THE BRAINSTEM. FOR MAXIMUMCURRENT IN THE BRAINSTEM, THE CURRENT SHOULD FLOWEITHER BETWEEN THE TWO MASTOIDS OR FROM AN ELECTRODE AT

10.

[PAGE 12]
THE BACK OF THE HEAD AT THE SASE OF THE OCCIPITAL LOBE TO FOREHEAD OR TEMPLE ELECTRODES. THE LATTER ARRANGEMENT IS SUPERIOR BUT IT INTRODUCED A NEEO 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 ELECTRODES, JUST OVER THE EYES.

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

LOOKING AT THE CLINICAL APPLICATIONS 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 OPERANOI OF REM ELECTRO-THERAPY INCLUDES: RAPID DISSIPATION OF REM HYPNOTCXINS, REHABILITATION OURING REM SLEEP, AND THE SUGGESTISILITY OF THE APPARATUS PER SE. THIS SUGGESTIBILITY MAY BE EITMER FACILITATIVE OR COUNTERACTIVE OEPENDING ON THE THOUGHTS WHICH WILL BE BROUGHT INTO CONSCIOUSNESS BY ASSOCIATION WITH THE STORED MEMORIES OF PAST EXPERIENCE. FOR EXAMPLE -11-

[PAGE 13]
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-SAND 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 FOUND THAT 26.7% OF THEM SHOWED NO CHANGE OR RESPONSE DURING OR AFTER TREATMENT, BUT NEARLY ALL BECAME DROWSY OR SLEPT AFTER RESTIMULATION WHICH FOL-LOWED THE ADMINISTRATION 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-STAGE SLEEP AFTER THE ELECTRODES WERE ATTACHED BUT BEFORE THE CURRENT WAS TURNED ON.

AN EXAMINATION OF ELECTROSLEEP CASE HISTORIES REVEALS THE  CONCLUSIONTHAT THE MAJORITY OF THE AILMENTS TREATED COULD BE DIVIDED INTO TWO DOMAINS - THE REM STATE AND THE NEUROGENIC DOMAINS, WHEREIN THE FIRST INCLUDES ALL CASES IN WHICH THE SYMPTOLOGY IS RELATED TO REM DE-PRIVATION PHENOMENA, AND THE"SECOND INCLUDES THOSE ILL-. NESSES WHEREIN REM ELECTRO-THERAPY WOULD ONLY CONTRIBUTE NEUROGENICALLY TO THE RELIEF OF SYMPTOMS 'RESPECTIVELY. THE REM STATE DOMAIN WOULD OBVIOUSLY INCLUDE INSOMNIA, DEPRESSION, SCHIZOPHRENIA, ETC. WHEREAS THE NEUROGENIC DOMAIN WOULD INCLUDE DERMATITIS, ULCERS, HYPERTENSION, ETC. WHEREIN PHYSIOLOGICAL CHANGES MIGHT ALSO BE IMRORTANT CAUSAL FACTORS. A QUANTITATIVE EXAMPLE OF THE NEURCGENIC DOMAIN IS GIVEN BY THE RUSSIAN STUDY OF 376 PATIENTS SUFFERING FROM ARTERIAL CONGESTION IN WHICH ELECTROSLEEP TREATMENTS PROVIDED SYMPTOLOGICAL IMPROVEMENTS IN 52%S OF THE CASES AND SLIGHT IMPROVEMENT IN 38%.

[PAGE 15]
THE MARGINAL BRAINSTEM STIMULATION OSTAINED WITH THESEGENERATORS ARE THAT THE EYES CAN ONLY TOLERATE A VERYSMALL CURRENT AND THAT ONLY SMALL CURRENTS SHOULD BEUSED FOR MINIMAL IRREVERSIBLE BRAIN TISSUE CHANGES.THERE ARE TWO KINDS OF BALANCED PULSES - SYMMETRICAND ASYMMETRIC WHEREIN THE CHARGE IN ONE-HALF OF THEASYMMETRIC PULSE MAY BE OBTAINEO BY A LARGER CURRENTFLOWING FOR A SHORTER TIME, AND VICE VEASA IN THE OTHERHALF OF THE PULSE. THE SITUATION IN THE SYMMETRICPULSE IS SELF-EVIDENT. THE EFFICACITY OF TME ALPHADRIVE OSCILLATOR IN THE INDUCTION OF SYNERGISTICEFFECTS WHEN SYNCHRONIZED WITH THE SENSORY STIMULATORSIS A MAXIMUM WHEN THE RECTANGULAR PULSES ARE BOTHBALANCED AND SYMMETRIC. THUS IT IS ESTABLISHED THATTHE CHOICE OF BOTH THE FORM OF THE CURRENT ANO THETYPE AND POSITION OF THE ELECTRODES ARE OF PARAMOUNTIMPORTANCE IN DETERMINING THE PERFORMANCE OF THE STIMU-LATOR.

一 CLINICAL PRACTICE WITH ELECTROSLEEP
STIMULATORS UNCOVERED A RECURRING PROBLEM, NAMELY, THE
AROUSAL ACTION OF AN UNEXPECTED OR UNUSUAL SOUND. IT
HAS SEEN FOUND EXPERIMENTALLY THAT WHEN A SUBJECT 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 OISCREETLY CHANGED BY A LARGE
ENOUGH INCREMENT, THE AUDITORY CORTEX WILL BE DEHASITUATEC
CAUSING THE AWAKENING OF THE SUBJECT, PARTICULARLY IF
IN THE REM STATE. THE PROBLEM WAS SOLVEO BY PLACING
THE MONOTONE TRANSMITTER IN THE STIMULATOR CABINET AND
TRANSMITTING THE SOUND THROUGH TUSES TO SOUND-TSOLATING
PLASTIC CUPS HELD IN PLACE OVER THE EARS. BY THIS MEANS
ANY EXTERNAL SOUNDS WOULD BE ATTENUATED TO A LEVEL AFTER
FILTERING THROUGH THE CUP WALLS WHICH IS FAR BELOW THE
THRESHOLD OF AUDISILITY CREATED BY THE MONOTONE ENTERING

;L.

[PAGE 16]
THE CAVITIES VIA RUBBER TUBES. THE MONOTONE APPLICATCR EXTENDS THE USE OF THE STIMULATOR BEYOND THE QUIET PRIVATE ROOM TO THE NOISY OFFICE ROOM OR HOSPITAL WARD.

IN CONCLUSION, AN ELECTRQPHYSIOLOGICAL STIMULATOR PROVIOING THREE BALANCED, SYMMETRIC AND SYNCHRONIZEO STIMULI - AUDITORY MONOTONE, ELECTRICAL FLICKER, AND ALPHA DRIVE - APPLIED TO THE HEAD VIA MONOTONE EAR CAVITIES, FLICKER TEMPLE OR FOREHEAD ELECTRODES,AND ALPHA ORIVE OCCIPITAL ELECTRODES RE-SPECTIVELY, CAN BRING A NEW ORDER OF EFFECTIVENESS TO REM ELECTRO-THERAPY..

15.