DREAM

From Big Medical Encyclopedia

DREAM (somnus) — the functional condition of a brain and all human body and animals having the specific qualitative features of activity of the central nervous system and the somatic sphere, other than wakefulness, which are characterized by braking of active interaction of an organism with the environment and the incomplete termination (at the person) the understood mental activity.

Studying of a problem C. has quite long history, but data on this matter for the first time were generalized only in 1896 by M. M. Manaseina. Early kliniko-morphological studies of a role of defeat of certain areas of a brain in an origin patol. drowsiness belong to the fr. researcher Gayet (Page J. A. Gayet, 1875) and avstr. to the doctor Mautner (L. Mauthner, 1890). The big contribution to physiology and pathology of conditions of wakefulness and S. brought K. E to zero which showed in 1926 on the example of a lethargical sleep at epidemic encephalitis value of mezentsefalno-hypothalamic structures in maintenance of conditions of wakefulness and Page. Later, in 30 — the 40th there are 20 century, in experiments on animals the importance of structures mezentsefalno - hypothalamic go a joint in ensuring wakefulness and a preoptichesky zone of a hypothalamus was confirmed — in S.

Printsipialno's genesis a new stage of researches in the field of a problem C. were works of I. P. Pavlov and his employees. According to the theory of higher nervous activity (see) I. P. Pavlov considered S. as diffuse cortical braking, considering that internal inhibition and S. on a physical and chemical basis represent the same process.

In 1944 the Swiss physiologist V. Hess found out that the electric irritation of visual hillocks caused the "behavioural dream" which is not differing on external manifestations from natural Page in experimental animals.

The following stage of development of ideas of the mechanism C. is connected with the analysis of a role of a reticular formation of a trunk in mechanisms of activity of a brain. In J. Moruzzi's researches and X. Meguna (1949) the extreme importance of the ascending activating influences of a reticular formation of a brainstem and hypothalamus on overlying departments in maintenance of wakefulness was revealed (see. Reticular formation ). At the same time was considered by page as a result of temporary blockade of the activating ascending influences with simultaneous «inclusion» of the talamokortikalny synchronizing processes. A little later the role of caudal departments of a brain trunk in emergence of Page was shown. These researches laid the foundation for development of ideas of the active nature of S. that then» was confirmed in animal experiments, and also on the person.

In 1953 an amer. physiologists Azerin-sky and Kleytmen (E. Aserinsky, N. Kleitman) opened a so-called phase of a REM sleep, having shown thereby, that S. is a difficult and heterogeneous state.

Allocate two phases of a dream — slow (FMS) and a REM sleep (FBS); sometimes the phase of a REM sleep is called a paradoxical dream. These names are caused by idiosyncrasies of rhythmics of EEG (see. Elektroentsefalografiya ) during S. — slow activity in FMS and more bystry — in FBS.

Electroprinting record during a normal dream of the person: EOG — an elektrookulogramma; EMG — the electromyogram of muscles of a diaphragm of a mouth; KGR — record of a galvanic skin response; The ECG — the electrocardiogram; EEG — the electroencephalogram in right central (Cd), left central (Cs), right frontal and central (CFd) and left frontal and central (CFs) assignments; and — a condition of quiet wakefulness before backfilling (it is given for comparison); autokinesias of eyes are reflected in EOG, on EEG the alpha rhythm prevails (it is specified by shooters); — the first stage of a phase of a slow dream: the slow movements of eyes are reflected in EOG, on EEG there is no alpha rhythm, amplitude and frequency of activity is reduced, separate delta waves (it is specified by a black arrow) and flashes of a theta rythm are observed (it is specified by a light arrow); in — the second stage of a phase of a slow dream: on EEG series of waves with a frequency of 13 — 16 Hz — so-called «sleepy spindles» (are specified by a black arrow), and also 2-3-phase high-amplitude potentials — K-complexes are observed (are specified by a light arrow); — a delta dream (the third and fourth stages of a phase of a slow dream): on EEG the high-amplitude slow delta rhythm dominates; fluctuations of skin potential — a galvanic skin response are observed; d — a phase of a REM sleep: on EOG the bystry movements of eyes are registered (are specified by shooters); on EMG — falling of a muscle tone, considerable fluctuations of skin potential (galvanic skin response); on EEG low-amplitude activity prevails, series of «sawtooth» potentials are observed (are specified by an arrow).

The FMS is divided into 4 stages differing in the bioelectric (elektroentsefalografichesky) characteristics and thresholds of awakening which are objective indicators of depth of Page. The first stage (somnolence) is characterized otsutstviyekhm on EEG of the alpha rhythm (fig., b) which is the most characteristic sign of wakefulness of the healthy person (fig., a), with desynchronization (decrease in amplitude) and emergence of low-amplitude slow activity with a frequency of 3 — 7 of 1 sec. (a theta - and delta rhythms). Rhythms and with more high frequency can be registered. On an electro-okulogramme (see Elektrookulogra-fiya) there are changes of biopotential reflecting the slow movements of eyes. The second stage (S. of average depth) is characterized by a rhythm of «sleepy spindles» with a frequency of 13 — 16 of 1 sec., i.e. separate fluctuations of biopotentials are grouped in the packs reminding a form of a spindle (fig., c). In the same stage from background activity stand out 2 clearly — 3-phase highly amplitude potential, K-complexes carrying the name, quite often connected — with «sleepy spindles». K-complexes are registered then in all stages of FMS. Amplitude of background rhythmics of EEG at the same time grows, and its frequency decreases in comparison with the first stage. Emergence on EEG of slow rhythmics in the delta range is characteristic of the third stage (i.e. with a frequency up to 2 in 1 sec. and with an amplitude of 50 — 75 mkv above). At the same time «sleepy spindles» continue to arise rather often. The fourth stage (behavioural the deepest S.) is characterized by domination on EEG of a high-amplitude slow delta rhythm.

The third and fourth stages of FMS make a so-called delta dream (fig., d).

FBS (fig., e) differs in low-amplitude rhythmics of EEG, and on frequency range in existence of both slow, and more high-frequency rhythms (alpha and beta rhythms). Characteristic signs of this phase C. are also so-called sawtooth categories with a frequency of 4 — 6 of 1 sec., the bystry movements of eyes on an elektrookulogramma in this connection this phase is often called a dream with the bystry movements of eyes (the FMS is called a dream without bystry movements of eyes), and also falloff of amplitude of the electromyogram or full falling of a tone of muscles of a diaphragm of a mouth and cervical muscles.

By page of the person and animals it is cyclically organized (see B iologichesky rhythms ). At the person duration of one cycle C. averages 1,5 — 2 hours (in a night 3 — 5 cycles are observed). Each of cycles consists of separate stages of FMS and FBS. The first emergence of FBS happens in 1 — 1,5 hour after backfilling after stages of FMS. The delta dream is characteristic of the first two cycles C., duration of FBS is maximum throughout III and IV cycles (usually it is early morning hours). On average at the person at young and average age of FMS makes 75 — 80% of duration of all S., at the same time the first stage — apprx. 10%, the second stage — 45 — 50% and a delta dream — apprx. 20%. FBS occupies respectively 20 — 25% of duration of Page. These values significantly differ from similar indicators at newborn children, and also at advanced and senile age.

During different phases and S.'s stages there are essential reorganizations in activity of a brain in general, its separate functional systems and visceral, endocrine functions. The research of activity of separate neurons during FMS showed that average frequency to them - a pulsation in most structures of a brain decreases though in nek-ry of them which are actively providing approach and S.'s course it increases in comparison with a condition of wakefulness. Not only frequency, but also the nature of neural activity changes. In visual hillocks and a cerebral cortex instead of a constant impulsation in a condition of wakefulness during FMS impulses are generated by series with the subsequent period of silence (to them - a pulsation like pack — a pause). During FBS activity of neurons of most departments of a brain amplifies, reaching the level of wakefulness or even surpassing it. The rhythm like pack — a pause is replaced by more constant neural activity again. Also excitability of neurons changes; in FMS in comparison with wakefulness it decreases and even more decreases in FBS.

Emergence of a peculiar electrophysiologic phenomenon — pontogeniku-looktsipitalny spayk (cycles), i.e. spayk arising in the varoliye-vy bridge (see the Bridge of a brain) and extending then in cranked bodies (see the Diencephalon) and a visual cerebral cortex where the visual analyzer is presented is characteristic of FBS. They are connected by Ilo of time with emergence of bystry movements of eyes.

In the period of S. there is an essential reduction of activity of motive system that is caused by active braking (see), coming from a brainstem. Expressiveness of spinal and bulbar mo-nosimpatichesky and polisinaptiches-ky motive reflexes decreases in FMS and even more in FBS. These changes caused by presynaptic and postsynaptic braking of activity gamma and alpha motor-neurons, lead to decrease in a muscle tone in FMS and to its sharp suppression in muscles of the head and a neck throughout FBS.

Despite the general decrease in a physical activity, during S. existence of various movements — from small (in the form of twitching of the face muscles, a trunk and extremities arising during the backfilling and which are becoming frequent in the period of FBS) to more massive (in the form of change of a pose in a bed), S. which are observed in all stages and the stages which are often preceding change is noted.

Essential change of a condition of the vegetativnovistseralny sphere of an organism is characteristic of S. The brain blood stream in FMS significantly does not change but to comparison with wakefulness, and only amplifies in nek-ry structures. In FBS it considerably increases, surpassing indicators of quiet wakefulness, and also temperature of a brain at the same time increases. These data, as well as the characteristic of neural activity, indicate high functional activity of a brain during S.

Prinyataya earlier the formula «dream kingdom of a vagus» was true only partly. During the backfilling and during the first stages of FMS the ABP really decreases, heart rate decreases and breath urezhatsya. At the same time can be and fiziol. arrhythmias of pulse and breath. In deeper stages of FMS heart rate and breath increases a little that perhaps has compensatory character and it is necessary for maintenance of optimum level of a system blood-groove and lung ventilation in connection with decrease in the ABP and reduction of depth of breath. In FBS indicators of activity of cardiovascular and respiratory systems sharply amplify. At the same time along with increase in the ABP, heart rate and breath their big dynamism which is shown noticeable arrhythmias of pulse, breath is noted.

Phase changes of vegetative functions are often connected in time with the advent of bystry movements of eyes in FBS and K-complexes or active movements of a body in FMS.

In parallel with characteristic changes on EEG the dream is followed by peculiar dynamics of other vegetative indicator — a galvanic skin response, edge, decreasing during the backfilling, again amplifies in deep stages of FMS and again is considerably braked in FBS. During S. certain dynamics of sizes of electroskin resistance, sweating, skin temperature is also observed. A characteristic vegetative phenomenon of FBS is the erection of a penis at men and a clitoris at women which is observed in this phase of a dream both at babies and at elderly.

In the period of S. there are essential changes in activity of endocrine system. It is necessary to consider that, e.g., reduction of allocation of AKTG and cortisol in the evening and at the beginning of night, and also changes in nek-ry other indicators of activity of endocrine system are connected directly with a circadian rhythm, but not with mechanisms C.

Dynamics of secretion of other hormones (somatotropic hormone and prolactin) have big communication with a dream. The peak of daily secretion of somatotropic hormone (see) falls on the period of delta stages of FMS in the I cycle C. Approximately during the same period also one of peaks of secretion of prolactin is observed (see), the last from to-rykh falls on early morning hours.

Mental activity in separate stages and phases C. also has the specifics. Peculiar visual objects (gipnagogichesky dreams) are characteristic of a stage of a somnolence. During the awakening of people from deeper stages of FMS it is quite often possible to receive reports on myslepodobny mental activity, sometimes about the indistinct visual objects which do not have that brightness, emotionality, to-rye are characteristic of the typical dreams (see) arising in FBS

In spite of the fact that the assumption of existence of the so-called centers C. was not confirmed, a number of formations of a brain is known, vigorous activity to-rykh provides emergence and S.'s course as physiological process. In a medulla and the varoliyevy bridge groups of cells are located, activity to-rykh causes behavioural S. and emergence of the corresponding bioelectric activity on EEG. Activity of this zone slows down activity of the reticular formation of a mesencephalon providing a condition of wakefulness. Other important link of the synchronizing (somnogenny) system of a brain is the preoptichesky area of a hypothalamus (see). It functions synergistically with a bulbar inhibitory zone and also slows down activity of a reticular formation, exerting impact and on other brain structures. Decrease of the activity of a reticular formation causes strengthening of functioning of kernels of visual hillocks, in to-rykh «sleepy spindles» are generated (EEG; fig., c), also includes the talamokorti-kalny synchronizing system in action; the progressing decrease in level of functioning of a reticular formation of a brainstem also causes deepening of Page.

Key structure, activity the cut causes the changes characteristic of FBS, is varoliyev the bridge, its separate reticular kernels, in S.'s regulation

also the structures of a new and old cerebral cortex (see) which are closely connected with a brainstem and an interstitial brain are important. Thus, it is more correct to speak not about the separate centers C., and about the existence of somnogenny system or systems of a brain which are in a certain functional integration with the system providing a condition of wakefulness.

The big role in regulation of wakefulness and S. is played by neurochemical processes. A number of neurotransmitters — noradrenaline (see), serotonin (see), dopamine (see Catecholamines), acetyl is known - care for N (see), piperidic acid (see) etc. — the conditions of wakefulness and S. participating in providing in general and their separate functional components. The condition of wakefulness is provided with interaction noradrenergi-chesky and cholinergic stvolo - in - diencephalic mediator systems. In experiments on animals it is revealed that in the varoliyevy bridge and a tire of a mesencephalon in a zone, the corresponding reticular formation of a brainstem, kernels are localized, in cells to-rykh the noradrenaline which is transported further on axons in various structures of a brain and providing maintenance of a condition of wakefulness is synthesized.

The Serotoninergichesky neurons providing emergence and course of FMS and FBS are localized in kernels of a seam of a varoliyev of the bridge. Not clearly, whether serotonin is a special «gipnogenny» mediator of a brain or serves as the anti-awakening agent not causing actually S. and who is slowing down activity of the nonspecific activating system. Noradrenergichesky kernels of caudal department of a brainstem, and also cholinergic mediator system participate in formation of FBS along with serotoniner-gichesky structures. Change of wakefulness and separate phases C. and interaction of separate mediator systems in this process is provided with existence morfol. bonds between them.

In S.'s regulation matters, apparently, not only interaction of separate neyrokhmediator, but also their metabolites and other agents. In particular, from blood of the sleeping animals polypeptide with a low hmol is emitted. it is powerful (hmassy), introduction to-rogo the awake animal causes in it Page.

A certain role in regulation of a cycle wakefulness — a dream is played, on-vidimokhmu, and endorphines (see Opiates endogenous), other polypeptides, in particular the so-called factor of R. relating to group of synoptic transmitters.

There is a number of the theories explaining S.'s emergence and its functional purpose. There is no uniform, conventional concept on this matter yet. Along with theories of «hypnotoxins», «diffuse cortical braking», «braking of activity of a reticular formation» there are also other views on this matter. In particular, information concepts With, assume that its function is processing of information obtained throughout a condition of wakefulness, unloading of a brain from redundant, unnecessary information, inclusion of its biologically important part in mekhanizkhma of memory (see). To etikhm to concepts the psychological concepts considering S. as a state are close, in time to-rogo there is a psychological processing of experience of the individual, stabilization of the Ekhmotsionalny sphere is carried out, so-called psychological protection is provided. There is an anabolic theory of a dream considering S. as recovery process, in time to-rogo power stocks of a brain and an organism in general are recovered. To it there correspond also the obtained data on course in vrvkhmya to S. of biochemical synthetic processes (protein synthesis, RNA in a brain and the somatic sphere, strengthening of secretion of somatotropic hormone etc.). The hypothesis, rasskhmatrivayu-shchy S. as one of types of an instinctive behavior of animals and the person is made.

Obviously, after all it is more correct to consider functional purpose of S. in a complex. In the course of evolution quite simple function C. (ensuring rest) what it is at the lowest stages of phylogenesis repeatedly becomes complicated, providing the regulation of all functions of an organism directed to its most effective interaction with the environment in a condition of wakefulness.

In the course of ontogenesis there is an essential reorganization of the organization of all stages and phases C. The structure of a dream (i.e. duration of its cycles, phases and stages), characteristic of the adult, forms generally in the pubertal period. Throughout all subsequent life its reorganization continues. At advanced and senile age shortening of duration of night S., lengthening of the period of backfilling, increase of awakenings and increase in duration of a condition of wakefulness in the middle of the night is observed. There is an increase in time of the first stage and shortening of the fourth stage of FMS, and also the period of all delta dream. Duration of FBS decreases. On EEG reduction of amplitude of «sleepy spindles», delta waves and their number otkhmechatsya. These changes serve as objective premises of frequent subjective frustration of S. in pozhilokhm age. The bi-phase organization of a daily cycle, characteristic of the person since children's age, hshet a tendency to reorganization on polyphase type (with day S. and discontinuous nochnsh).

The reason of changes of the organization C. at the person at advanced and senile age are the factors of a biological and social order influencing its somatic and mental sphere.

It is revealed that intensive physical and mental activity increases duration of a delta dream in the evening, and the long hypodynamia causes S.'s frustration up to the expressed pnsokhmniya. A great influence on S.'s regulation make Ekhmotsiogenny impacts, to-rye depending on individual reaction of the person to them can break night S. or cause adaptive izkhmeneniye of its structure.

Considerable izkhmeneniye of S. are connected with sharp change of time zones of a daily cycle of illumination. At bystry change of time zones in the first days wakefulness — a dream with a day-night rhythm can be broken communication of a cycle. Also the internal structure of S. Proiskhodit shortening of the first stage, reduction of number of transitions from deeper stages to more superficial, increase in relative duration of a delta dream changes.

Subjective and objective changes in S.'s structure at inhabitants of middle latitudes in unusual conditions of polar night and polar day for them are noted. These changes can have various expressiveness and to some extent depend on extent of biological and psychological adaptation of the person to polar conditions (see Acclimatization). Izkhmeneniya of ambient temperature, excess noise influences also break Page.

On S.'s course a certain impact is exerted also by a state hmag-nitosfer (ShM. Klimatopatologiya). In vrekhmya magnetic storms there can be subjective and objective frustration of Page. The cyclic organization C. changes at elimination of natural temporary sensors (e.g., at enough dlitel-nokhm finding of the person in deep caves).

At a research C. of the person use various methods. Most prostsh method of evaluation test of S. is traditional poll. From it pokhmoshchyyu it is possible to sketch ideas of S.'s features throughout human life, bonds of izkhmene-niya of its quality with the exogenous or endogenous reasons, to find out urgent characteristics of Page. At special researches, in to-rykh more exact and total characteristic of S. is required, use standard cards questionnaires with a vozkhmozh-nost of answers to the questions posed on the type "yes", "no". At the same time features of value judgment of S. ispytuyekhmsh are analyzed, compare with results \sh researches of other subjects in similar group, compare various groups. Such method of a research C. is only possible at inspection of the big contingent of people that is necessary in the analysis of influence various ekzo-and endogenous fiziol. and patol. factors.

It is important to mean that these methods of studying of S. give only value judgment, not always rather precisely corresponding to objective characteristics.

The most objective way of assessment of S. is continuous record of several of its electrophysiologic characteristics (EEG, EMG of muscles of a diaphragm of a mouth, an elektrookulogramm).

The dream at children

Wakefulness and S. — the interfaced states, i.e. active wakefulness promotes S.'s glu-bokokhm and, on the contrary, sufficient on duration and S.'s depth provides active wakefulness. The newborn child has S.'s periods and wakefulnesses are arrhythmic, they arise chaotically. At the same time the strongest irritant capable to break S., hungry excitement is. The child sleeps almost all the time, but his S. uneasy, superficial. The general duration of S. at the newborn makes 16 — 20 hours a day. At the end of the 1st month of life at the child under the influence of natural irritants in the environment and on the basis of the daily need for S. the day-night rhythm of S. and wakefulness forms.

The quantity of the irritants coming to a cerebral cortex is sharply reduced in comparison with day time at night owing to what there is S.'s concentration in the night period, and wakefulnesses — in day. Education at the child of rhythm of alternation of conditions of S. and wakefulness in a day part of days requires creation of special conditions for bystry backfilling and strong S. in the hours intended for S. and an active state in the hours intended for wakefulness. As a result of the special researches conducted by H. M. Shchelovanov, H. J1. Figurin, etc., established daily need of the child for S. and duration of each piece of the day S. changing with age. The child in process of a growing is capable to be awake without signs of exhaustion more and more long time, at the same time the quantity of pieces day S. Tak decreases, the child at the age of 5 — 9 months sleeps in the afternoon 3 times, after 9 months — 2 times, and since one and a half years throughout early and preschool age — 1 time. Night S.'s duration remains almost without changes (10 — 11 hours). With age S. changes not only quantitatively, but also is qualitative; it becomes deeper, quiet.

It is known that during S. the energy potential of cells of c is partially recovered. the N of page, to-ry is spent during wakefulness. In it guarding value of a dream. The full-fledged dream is reached at observance of a number of conditions. In particular, the child shall sleep in the darkened room where there is no noise, it is very important to provide it sufficient time of day S. (according to age) since, from the point of view of health protection, premature transfer from two times day S. on one-time is harmful to the child or in general deprivation day S.

Boley promotes bystry approach of S. and its maintenance long influence of any the operating irritant weak rhythmic. It is useful, especially in the first 2 years of life, S. in the open air. The movement of fresh air is the weak tactile irritant for skin, mucous membranes of a nose and upper respiratory tracts promoting bystry backfilling. Fresh air is not only lulling, but also a recreational factor.

In process of development of the child there are essential high-quality shifts in the organization of nervous processes during Page. They can be objectively estimated by registration of vegetative and motor reactions, and also EEG. Considerable shortening with age of the periods «uneasy», or «active», S. at rather little change of duration of «quiet» S. established by means of quantitative assessment of frequency and rhythm of breath, cordial reductions and the general physical activity correlates with evolution of biopotentials of a brain of the child. «Maturing» of the systems providing synchronized S. is followed by formation of mechanisms of reciprocal interaction between slow and bystry phases of a dream. A. N. Shepovalnikov (1971) considers that bystry S. of the newborn is not similar to FBS of the adult and in the course of age development only gradually reaches its characteristics. During S. the brain can function at the level corresponding as if to its lower stage of ontogenetic development. E.g., children during S. can have motive reflexes characteristic of earlier age period (the search of a breast which normal is observed at children to 7-month age).

In the course of ontogenetic development of the person there is a quantitative and qualitative change of an elektroentsefalografichesky cycle C. and its separate components. These changes are most considerable aged up to 6 years. The absolute duration of S. decreases by 20 years though individual distinctions in duration of a dream remain throughout all life.

Frustration of a dream

mean two groups By S.'s frustration: disturbances of a condition of wakefulness, or hypersomnia, and S.'s disturbance, or insomniya. S.'s frustration the first group the cerebral disturbances which are followed by insufficiency are the cornerstone of the ascending activating systems of a reticular formation of a brainstem. S.'s disturbances, i.e. insomniya, can be a consequence of excess activation of the ascending systems of a reticular formation, and also disturbance of activity of the synchronizing systems of a brain (the bulbar centers of a brainstem, kernel of a varoliye-v of the bridge, a preoptichesky zone of a hypothalamus and visual hillocks providing emergence and a current of FMS, and also the reticular caudal kernel of a varoliyev of the bridge and a blue kernel realizing a current of FBS). Disturbances of functions of the brain integrative systems located in a limbiko-reticular complex have special value (see. Limbic system), to-rye provide normal change of processes of wakefulness and S., adequate adaptation to specific conditions of existence. Very often S.'s frustration are symptoms of mental diseases.

The variety of disorders of processes of S. and wakefulness caused need of elaboration of their classification. The fullest is the classification offered in 1979 to H. N. Yakhno and A. M. Vey - number. According to it two basic groups of disturbances, i.e. hypersomnias and insomniya, are subdivided into subgroups. In group of hypersomnias allocate: narcolepsy (poly-simptomnuyu and monosimptomny); syndrome of an idiopathic hypersomnia; hypersomnias with disturbance of breath in a dream (idiopathic and symptomatic); syndrome Klein — Levina; syndrome of a periodic psev-dogipersomniya of hysterical genesis; syndrome of a periodic pseudo-hypersomnia of epileptic genesis; gipersomnichesky states after epileptic and vegetovascular paroxysms; paroxysmal gipersomnichesky states at metabolic disturbances and intoxications; gipersomnichesky states at organic diseases of c. N of page, mental, endocrine and somatopathies. The group of insomniya is divided into partial insomniya; full insomniya; psevdoinsomniya; idiopathic giposomniya.

Hypersomnias. Narcolepsies (see) are characterized by insufficiency of the ascending activating influences of the reticular formation which is combined with a superactivity of the brain systems responsible for formation of FBS; it is shown by imperative attacks of day backfillings, a cataplexy (see), gipnagogi-chesky or gipnopompichesky hallucinations (see), night S.'s disturbance with bright, frightening dreams.

The syndrome of an idiopathic hypersomnia is characterized by the day drowsiness (a little less imperative, than at a narcolepsy) which is combined with night S.'s lengthening and is frequent with a syndrome of «sleepy intoxication» (feeling of the fatigue, weakness slight for confusion of consciousness after night S.). This form of a hypersomnia arises at persons with disturbances of the emotional sphere or against the background of moderate hypothalamic insufficiency.

The idiopathic hypersomnia during S. (incidental apnoeas, or an apnoea) meets disturbances of breath seldom. The apnoea causes qualitative and quantitative inferiority of night S. and attacks of day drowsiness. Symptomatic forms are connected with the functional or organic pathology of a brain leading to disturbance of the central regulation of breath — a syndrome «Ondina's punishment» (meets seldom), a pikkviksky syndrome (see). If the syndrome «Ondina's punishment» is connected with disturbances of the central mechanisms of regulation of breath (see), then at a pikkviksky syndrome an important role is played by the obesity (see) leading to restriction of mobility of a diaphragm, obstruction of upper respiratory tracts. A characteristic sign of a pikkvik-sky syndrome is, in addition to a night apnoea, intensive snore and cardiopulmonary insufficiency. A night apnoea can be connected also with new growths of a nasopharynx (adenomas, polyps). Day drowsiness has compensatory character in connection with the expressed disturbances night S.

Sindr Kleyne — Levina is shown by attacks of imperative drowsiness duration from several hours to several days; it is observed almost only at young men at pubertal or post-pubertal age. It is combined with psikhopatol. disturbances and an izkhme-neniye of inclinations in the period of an attack (e.g., bulimia, a polydipsia).

Sindr of a periodic pseudo-hypersomnia of hysterical genesis («hysterical hibernation») it is characterized by paroxysmal snopodobny states duration from several hours to many days which are usually arising in connection with the psychoinjuring situations; it is more often observed at the women having and other signs of hysterical disturbances (cm. Hysteria). On EEG at the same time find a picture of wakefulness and vegetative activation (tachycardia, raising of the ABP, a hyperthermia etc.).

Sindr of a periodic pseudo-hypersomnia of epileptic genesis meets seldom and it is characterized by paroxysmal snopodobny states. On EEG reveal accurate epileptic activity, the peak waves is more often in the form of the following one after another. Sindr represents option of convulsiveless forms of the epileptic status and can arise in a concluding phase of generalized epileptic attacks (see Epilepsy), during paroxysms of migraine (see), at hypoglycemic states (see the Hypoglycemia), a liver failure (see).

Gipersomnichesky syndromes of permanent character arise at neuroinfections, tumors, intoxications when in patol. process gipotalamomezen-tsefalny educations are involved, and dynamics is defined by an etiology of a disease. Manifestation of hypersomnias of this type can have topical value.

Iyesomniya (sleeplessness). Partial insomniya — the most common form of sleep disorders. It is shown by subjective dissatisfaction with night S., its depth and duration. Signs of a partial insomniya — the complicated backfilling, awakening in the middle of the night, early morning awakening. Among the reasons of a partial insomniya the leading place is taken by neurotic and mental disturbances, and also various neurologic and visceral frustration. Easy forms can be connected with situational factors (external hindrances, an unfamiliar situation, etc.). At an electrophysiologic research C. its small reduction, lengthening of the period of backfilling, insufficiency of deep stages of FMS and (or) FBS is defined. At dominance at the patient of signs of an alarming state difficulty of backfilling and frequent awakenings are observed, and at depressions (see. Depressive syndromes) — early morning awakening. Excess fixing of attention of patients on the available disturbances of Page is noted.

The full insomniya meets extremely seldom, lasts shortly; arises at reactive or endogenous mental diseases (see. Mental diseases, Reactive psychoses).

At a psevdoinsomniya patients complain of shortening or S.'s absence; at the same time main electrophysiologic characteristics of S. of a sokhranna. The expressed emotional disturbances are noted.

The idiopathic giposomniya meets seldom. At this disturbance of S. almost healthy people sleep till several hours a day, without complaining at the same time on insufficient night Page.

Treatment of disturbances of S. and wakefulness includes etiological, pathogenetic and symptomatic approaches. Treatment of a narcolepsy is based on strengthening of activity of the activating system and suppression of excess activity of mechanisms of bystry Page. Psychogogic effect anorexigenic drugs (Phepranonum, Desopimonum, etc.) render, Sydnocarbum or Sydnophenum applied in morning and day time. By means of antidepressants suppress FBS. Positively influence cataplectic manifestations Melipraminum, and in some cases L-DOFA. Night S.'s improvement about a nek-eye by reduction of day drowsiness gives reception of hydroxybutyrate of sodium. Complex treatment is most justified. At an idiopathic hypersomnia Sydnocarbum, Sydnophenum are effective. The hypersomnia with manifestation * a pikkviksky syndrome successfully recovers at weight reduction on 10 — 20 kg — a diet, an exercise stress, drugs of potassium, diuretics. The hypersomnias connected with neurotic mechanisms demand treatment of a basic disease. At epileptic hypersomnias in combination with migraines, metabolic, endocrine and organic diseases of c. the N of page needs treatment of a basic disease. At a partial insomniya it is necessary to pay attention to treatment of a basic disease (neurosis, an endogenous mental disease, a pain syndrome etc.). Considering a role of neurotic frustration of S. special significance attach to various forms of psychotherapy (see), and also to a day regimen, a physical hardening, use of psychopharmacological drugs — tranquilizers and antidepressants. It is necessary to appoint hypnagogues carefully, considering their quite often adverse effect on S.'s structure and a possibility of accustoming to them. Drugs of a valerian, motherwort, valocordin can help with cases of easy disturbance of S., to-rye accept antihistamines (Pipolphenum, Dimedrol) before S. Pokazana. Small tranquilizers are effective (Tazepamum, Valium, etc.). The good effect and favorable impact on S.'s structure render Phenibutum and especially hydroxybutyrate of sodium. With success acupuncture is applied (see Acupuncture). In cases hron. S.'s disturbances long reception of the same drugs in constant dosages is recommended. Frequent change of drugs, their cancellation and appointment exert adverse impact on S.'s structure and, as a result, on efficiency of treatment of frustration With,

the Forecast depends on the reason which caused a sleep disorder.

Frustration of a dream at mental diseases are a constant psychopathological symptom of an onset of the illness and at recovery very often disappear the last.

Allocate two main types of such frustration — a hypersomnia and an insom-niya (see Sleeplessness).

The hypersomnia on the intensity fluctuates from easy drowsiness to a lethargy (see), can be discontinuous and continuous. The discontinuous hypersomnia is shown by attacks of drowsiness lasting from seconds up to several minutes. This type of disturbances of S. is observed at a narcolepsy, temporal epilepsy, a pikkviksky syndrome. The continuous hypersomnia lasts from several hours to several months; it is observed at various forms of weak-mindedness (see), including at senile dementia (see), an idiocy (see Oligophrenias), at an endocrine mental syndrome (see). In some cases expressed, long and accruing on depth hypersomnia appears as if against the background of full health. Various encephalitis (see), tumors of a brain (see), and also the syphilis of a brain (see Syphilis) which is followed by development of gummas, especially big solitary and at defeat by a syphilitic infection of basal departments of a brain can be its reasons. A hypersomnia — a constant symptom of a trypanosomiasis (see), and also many somatic and inf. the diseases proceeding with high temperature. The hypersomnia which is shown in easy drowsiness arises at the asthenic syndrome (see) which is observed at a neurasthenia (see) or after acute symptomatic psychoses (see).

Insomniya is characterized by reduction of duration, S.'s depth or its total absence. At an insomniya S.'s frustration is possible at all stages — during the backfilling, in the period of actually S., during the awakening. Backfilling can drag on for vaguely long time, and in some cases not pass into the Village at all. At disturbance of backfilling gip-nagogichesky visual and auditory hallucinations and pseudohallucinations (see Hallucinations), a mentism are possible (see. To andinsky — Klerambo a syndrome), persuasive conditions of burdensome contents (see. Persuasive states). In other cases deep S. comes quickly, but in several hours is replaced by awakening, later to-rogo the patient cannot fall asleep any more. At discontinuous S. the patient in the middle of the night repeatedly wakens; often such awakenings are followed by the expressed concern, fear, vegetative frustration (cold sweat, heartbeat, feeling of shortage of air, etc.). Lunacy also belongs to night S.'s frustration (see Somnmbulizm). In the period of awakening of disturbance of S. are most often shown by kataplektopodobny frustration and a morbid prosonochny condition (intoxication a dream) — at the incomplete and slowed-down awakening there are dreams, quite often dreadful, there can be automatic actions, including dangerous to people around or for the most sick.

Very often the insomniya is shown in reduction of depth of Page. It becomes superficial, as if promezhutochnsh between S.'s conditions and wakefulnesses: the patient dozes, vaguely hearing what occurs around. Usually superficial S. is followed by multiple dreams, to-rye at many psychoses «on vivacity of paints do not concede reality». At nek-ry mental diseases, napr, at epilepsy, delirium tremens (see. Alcoholic psychoses), arise dreams, the nonsense, hallucinations, fear, melancholy, etc. observed at the patient with mental disorders in the awake state become contents to-rykh. In some cases the patient is not able to distinguish similar dreams from occurring in reality. The dreams reflecting mental disorders can remain and when sleep disorders already disappeared. In psychiatric practice also loss of feeling of a dream belongs to an insomniya: despite existence of objectively stated S., patients are subjectively sure that they did not sleep all night long. Most often such frustration is observed at depressions.

Insomniya is observed at the beginning of all psychoses, at to-rykh there are conditions of stupefaction (see), in debuts of endogenous psychoses, especially those, the wedge, a picture to-rykh is defined by figurative nonsense (see Nonsense), affective frustration (see. Depressive syndromes, Maniacal syndromes). The insomniya at patients with maniacal states is especially expressed. Such persons can sleep only one-two hours and even not sleep all night long. Insomniya constantly arises at the beginning of development of reactive psychoses and gallyutsinoz, especially in cases of dominance of the verbal hallucinations (see Hallucinations) amplifying in evening and night time.

Insomniya — a frequent symptom at patients with the erased forms of endogenous psychoses, first of all at patients with a cyclotymia (see M aniakaljno-depressive psychosis), and also at patients with boundary mental diseases (see Neurosises, Psychopathies). As a rule, S. at them superficial and discontinuous, is followed by the dreams reflecting real vital problems.

Treatment. At S.'s frustration in case of psychosis treatment of a basic disease is shown; at the erased forms of psychoses and boundary mental diseases elimination of the reasons promoting an insomniya is necessary (food for the night, smoking, the use of tea and coffee, surplus of external impressions, naira, telecasts, etc.). From pharmaceuticals tranquilizers (see) and antidepressants have major importance (see). In all cases the psychotherapy, in particular those its types is shown, to-rye cause a relaxation and can be carried out by the patient personally — i.e. an autogenic training.

Forecast. S.'s normalization at the patient occurring along with improvement of its mental state is usually favorable sign testimonial of recovery (see) or remissions (see). Improvement of a mental state without simultaneous normalization of S. — the evidence of incomplete recovery, and in cases when the disease proceeds attacks — a harbinger of possible return of mental disorders. S.'s improvement or its full normalization which are not accompanied with simultaneous improvement of a mental state often testify to the adverse course of a mental disease. At borderline mental cases and the erased forms of endogenous psychoses, especially with symptoms of a depression, the long insomniya can cause regular reception of hypnotic drugs and, as a result, development of toxicomania (see). Most often the barbi-turatizm develops (see), and in cases of use as a hypnagogue of alcohol development of symptomatic alcoholism is possible (see an alcoholism).

Treatment by a dream of mentally sick. In psychiatry S.'s treatment is used since the last quarter of 19 century. Originally S. applied almost only for fight against conditions of psychomotor excitement (see Excitement psychomotor). As hypnagogues during this period used Chlorali hydras, paraldehyde, barbiturates. In 1922 J. Klaesi, and in 1934 Mr. Kloetta (M. of Cloetta) and A. Maier applied treatment by continuous S., at Krom patients slept almost whole days for 4 — 7 days. As a hypnagogue appointed high doses of barbiturates and somnifen in the beginning, and then the special mix consisting of paraldehyde, an amilengidrat, Chlorali hydras, alcohol, a digalen, ephedrine and one of drugs barbituric to - you. Hypnagogues were entered by per os or by means of an enema through certain time slices. At the same time there was not so much S., how many the state close to a long anesthesia (see Hibernation artificial). Therefore, despite the accepted precautions, therapy by continuous S. was followed by often serious somatic, neurologic and mental complications, up to lethal outcomes.

A new stage in S.'s use how to lay down. a factor it is connected with works of domestic psychiatrists. Their researches in this area were based on I. P. Pavlov's doctrine about higher nervous activity (see), and in particular for roles of guarding braking (see). Discontinuous S.'s technique, on a cut from the general duration of S. equal of 17 — 18 hours in days was developed, discontinuous S. made a half or 3/4 night S. Pomeshcheniye of patients in special chambers provided their isolation from external irritants and allowed to apply rather small daily doses of hypnagogues, first of all barbamyl; the coming S. was close to physiological. The general duration of treatment of S. made 2 — 3 weeks. Complications were rather rare and not heavy. The method of treatment by discontinuous S. gained distribution in the subsequent in other countries, in particular in France. S.'s treatment was used more often at endogenous psychoses and neurosises. It turned out that this method not only improves a mental condition of patients, but also facilitates a possibility of use of psychotherapy (see). Since the beginning of the 50th of 20 century S.'s treatment was forced out by therapy by psychopharmacological means (see).



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H. H. Yakhno; A. M. Vane (nevrol.), P.B. Tonkova-Yampol (ped.), N. G. Shumsky (psikhiat.).

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