Medicine: Sleepy Talk

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Doctors have usually been content to leave the subject of sleep to the poets, but now they are being forced to give it increasing attention because, in high-speed modern society, insomnia is leading to an alarming dependence on drugs.

At its annual meeting in Glasgow last week, the British Medical Association found the matter pressing enough to open its scientific session with a serious discussion of sleep and the lack of it. Physicians from far-flung Commonwealth countries as well as those from Britain proper squirmed in comfortless, sleep-discouraging seats in garish Kelvin Hall and listened with never a wink or a nod to a panel of experts.

Sir Geoffrey Jefferson of Manchester, one of the world's top brain surgeons, faced up to the fundamental question of what is sleep, and had to admit that nobody really knows. But it is definitely not the same as unconsciousness: for man it appears to be a conditioned reflex.

Neurosurgeon Jefferson disposed of some medical fallacies, e.g., falling asleep has nothing to do with changes in synapses*— in the nervous system, or a shortage of blood in the brain, or accumulation of lactic acid. Neither is there, as some used to think, a sleep center in the brain.

Instead. Jefferson agreed with research which suggests that there exists a waking center within some nerve cells in the brain stem and basal ganglia called "retic-ular formations." Sleep comes when this waking center is deactivated, probably by enzymes. But how this happens is unknown.

Sir Geoffrey disposed of some popular fallacies as well. Examples: "There is no optimism period that each individual should sleep each night"—the traditional eight hours is a baseless fetish, and there is no physiological reason why the sleep must be taken in one shift without interruptions.

The mother who sleeps through the roar of an airplane overhead but leaps up at the first little whimper from her baby is not necessarily sleeping less soundly or restfully than her husband. Impulses from the higher brain centers are "fired back" to the waking center, and the mother has conditioned herself to respond only to certain ones.

Said Neurologist Macdonald Critchley of London: "Sleeping little matters little.

What does matter is the anxiety it produces." One doctor's prescription for those whose inability to sleep is due to an empty stomach: "A plate of good thick porridge." Concerned because 10% of Britain's National Health Service prescriptions nowadays are for barbiturates, Professor Derrick Melville Dunlop of Edinburgh complained that "the average city dweller wants to be able to turn sleep on and off like a tap." He advocated abandoning bromides entirely because they are useless for insomnia, and urged the prescribing of barbiturates only sparingly and for short times—while the patient is being taught to relax and not to lie awake worrying about when he will get to sleep.

Insomniac patients, the doctors agreed, cannot be talked or cajoled out of their sleeplessness, but require sympathetic treatment. "What do you do about the patient who complains, 'I haven't slept a wink,' when you know he has slept for hours?" Sir Geoffrey Jefferson was asked.

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