TE! JolrNe o, N!Eyo!.

rND lIErr^L DrsEruE

CoDyrisnt O l07t by Tho rYilliaB. & DiEins Co, .,,*|,.T1.1:i1

THE TREATIIENT OF INSO1IINIA THROUGII TIIE USE I

t
OF ELECTROSLEEP: AN EEG STUDY !

ll'\lrc r. \\'EISS. lL.{.' I

I
In orclel to 10,.t\tictLer oL! troJlecp is an effe(tive thetapcrttic ptoccdure, a

its effctts rtele as:r',..rrl (nr tlx.nrost conruron ol sleep disordcrr, ,(lccp onset I
insonrrria. Thr, proscrrt rc.crlr,h l-ls rlcsigued to nvoid tltc irradcquacies of (
preliou,. i vcstigntiorrs l^ ut rrsilg a clouble Llirul l)roccdurc; l)r usirg ob- (
jcctivc ey:rlu.ltior) pl'o(.(h[('s lIjlic recordirlgs); {r](l cl njillg thc r( coDr- i
nrendcd ;tutrrLcl ru(l (lirtril)rliou of trcatDrcnts. Arlditioralh', ruLj.cti!e
slcep claluittion rrrrrl 1x,r'.orulit1'-I-.1'cholrathology clrtt $-rrc ol)tniu('rl. t
l-cn lolLrnt(r(x,i $itlr ol)jot,tircl) rstibliihcrl in.onrrria rrcrc Ianclotttly ts- t
sigrrerl to one of tlo r,\l)crin)cntrl con{litions. 'fhcse cortditiolr: \rerc clcctro- T
slccp ireatnnrrt rrr(l sinnlhtcrl clo(troslorl) ttcietllt{rltt. Itritirllll', eacll stll) I
ject (S) spentl 3 ;rrcccssilc rights in lllc slcep l:rborator!' for tlre liE( l-liOG
moDitoring of hi-. r'isht{irnc sktt) t)rttct,rs- 'l'hi! $rti IolloNcd Iry Ir .c cs I
oI 24 rlaytimc "tr{,ntr)x,rt!," cr(h l5 rnir)utos iu drrration. Ioilowiril this
phasc, cach ,S rrguin s|c[t 2 rrighls ir tl)(' sl{\]) l*borato$', at \\'hi(11 time c
posli-trcatmcxt (lli{1s $(,rc rncrstrrc(1. ,{ftcl i4 lx)-trcaln)cllt rILr's, r'rrclt S T
rcttrr)cd to thc sl{{'l) Iill)ollllorY lor follon-uI tl).ilslllcttlcrrt. l)
Oll the basis ol lili(i rrrorr'rtrr'.,, tlr(r aotutll troatlllcrlt grolll) oxhil)il({l a I
strtistically significn l (l(clirrc ill th('lat(,rrc) oI slfi]] otl-.ct, lxjrceDtngc of e
total Lod timo tNrrkc, arrrl t,(.r(cntagc ol totrtl sl('cl) tirnc' irr sttrgc I slocp d
A significani iDcl0asc iI tLe t)crro trrge of total slc(,t) tiru! ir stagc 4 rrnd i
tolrrl (lelta sle{rt) \'rls foLlrl..\rlrlilionolll', sul}icctivcl}' rot)o}l({ ltrtcrx,ics of il
slcep oDSet de(iin(l sigrilirrllrtll'. Thcso l)ost-tlcstrncnt rc-.tllts \\'cre txBin- 8

tained at follorv-uP. Signili( rIrl ilillcr(rl(ros tcre Dot foun(l irr thc sirnuLited ll
lrellirncnt grolrl,. h

Possible grotp tlifTclcrrlr:s irr rLgr:, rtlorricity of irrsoxnria, l)s-"-chol,{rll)ol-

ogy, sex, psdicil)ation ix l)st (lrollrcnrt)y, placcbo reactility arrd suggcstibil- 1'

ity arc cliocusscd ib t(,1)ls of lL ']icle(iljvc" placebo cffect, Thcse altcrnatives cl

arc discounted bcfore con(lu( lirrg thrt clc(:troslccp is truly an cffectiYo thcta_ ir
peutic prccedulc in tht tr'('atructrt of slecp otrset insomnia.
cl
sl
Electmsleep has been dcscribed as "a guishable Irom ordilary slcep, ])roduced bX
sirte of consciousDess grossly il)Llistin- tlro direct action oI tt rvcak rhytbmic cu' si
rent on the Lrain of a co-oper,rting subjeci
'Tl)is ro|ort is based in polL on a mastcr's ll,csis in a nondistraciing cnvironmcnt" (2, p 9),
strbmitl€d to the graduate fsculty oI thc UDilersitv h
of Illinois :rl Chicaso Circlc, Dcpartmeni of Psy- To initiate this state loriotts clectmslcel 8(
cl olosr, Chicaso. Illinois 60630. devices manufacturcd in thc L)lited Stat€s,
The autlor $isles to cxpre$ his de.rsl 8r'nti- u
tude to his advisor, Dr. Rosdind D. Crrtrvrisht, Errrope ond .lapan hnve becn uscd. tr
for srrl,crvisiDe thi-. rcseorch. The ilnleius lor elcctroslonp rcscarch n0! sl.
TLis r.searclr Nns support.d bI finil,al Sirl.s ri
Public Heatth Service Grsnt 1R0 r MH 18040 lo ILL Lnivur:ir\' of Illinois sl Cl,i,-su CrLcl'. Dc
Dr. F.osalind D. Cart{riBht. r.",'i,,""r iir*t.Lgr. Bor 3438. Cr,i.igo. IlhooiJ
Beprints E1ry bc reqncsted Irom the author at: 60680. "i
108
 TREAaMENT OF INSO:\rNId BY ELE(yI&OSLIEP 109
.,,*Itillx
fro6 the rheoretical anJ experimFnEal Ss had "partial remission" oI symptoms
-"
*j-i pu"tou. He s{ates, "forcign stimuli and 13 $'as a "trcotment failure." The
E USE
"t
l.li"i uay t" rcr,crtcA titl,u'rt furrlrcl ron- roost ma,rked change \r&s on the clinical
the arlilnal al'o tlrrnrrglr lheir sleep distulbance and aDxictl sclf-ratings.
I'o,,uen,a fot
"'"- flc"ts alono l, ad to ll.n delnlol,rnnn' of Duc to Urc fuct thrt the 8s in this study
l" tnt,iUito.l condilion irr ILP(.ltenr cor'{e\" (8 p' \\'ele undergoing "psychiatric treatmeni"
c ploceclure, "1. -r.:"
""ninnl inLil,itiou r,rotects fo: 15 Lo 30 mirutes on a rnoDthly or bi-
, -.lccl) onsct T' -l]ii""-i
lIe (u' _"_' ""1. tior,r s,irlii,c l,c'oi,.l their uroDtl)lt' blsis &nd $cre suddenl]' stitched
rlrlrrrrcics oI Ir.tl,".n,ot, , tlre otr I r, olliing of to {r 60-minute l)eriocl on rr daill' basis, it
lrt u.irrg ob-
"."n.i1 . i' r.lilod to nourojii:rnd \'rl- \\'a,. r'cxsoned th{lt thc cfrects of the treet-
-'rti"otcells disortlels lneni could be aihiblltccl io suggestion. In a
itllc r(,cotl)- inus functional 1261
', suLjcciive EloctxoslepP lroalmen{' rra ttpicslll 30 sinele blind stud) (12) Ss s'oe nssigned to
,l ,t il ir ), 1l
to m minutes in
!lrrritinn, lol I l,criod of 5 trcainreoi and simulotecl trr:atmcllt condi-
ro i0 days. sitl, no si,lc
lrrrdorrlt lts- nflecti lrcing re- tions. Thc cvaluatioD proccdrrrcs used in
oor[ed. This mflJ-bo 'onrrl.l'LI
sil)r 1'lrrr- this study wcre idcnLicll to those employed
i, r.rch sub- m11rcutically indunr'l slnnp llr'rrlrl- in iu thc previous -<tudy. In the trcahnent con-
. dition I Ss lrtrd "r'e)atively total rernission"
$.hich treetmcnts c conti lous over &
, I.tI.t(
l-DoG
L5' rt sr:rics mn0h longer pcriod tnd hrtve associ:lted &d_ of thcir syrnt,loms, , S had l,rrtifll r.mis-
,llotlirrg this vcrbc sidc effc(t:. Tlre'e offcr"ts lrnro itl- sioD" und 2 Ss $cre "lt.caimcnt lailures." In
Ir'hir.h time cfudcd altcrations of tlc
"normal" slccp the sinrulatcd trcatmcn[ conditiol 4 Ss e\-
LLvs, cacL S 0[licrns, !hal i. l In,]rr.tiorr in rr1,id ele hibittxl an "improvemcni" \\'hereas 2 Ss
inovcmnnt (RE\lr an,l dpllrL rprimarily r\.cre unclunged. HoNcler', thoso rrho did
cxlriLitcd a stnge 4) sleep, Ps5'chophysical and bio- sllov rtn ilnl)rovement did not displa-v the
alccrtrgc oI chcmicrl changes suclt as drug withdra.1\-ol, "nrarkrtl imprrcvemeut" found irt the nctual
rgc I slccp. dcpcndence, and adclictiolr trc {rlso encortn- irc&trDcnt condiiion. Jt rvas corcluded that
sla,Ic .t and tclcd (3). Thus, there is fl grc^t need fol o iDrprolcmenI can be attribrrtcd partially to
lrt(lx ic! of t[cmpeutic proccdure, \lithout associated slrggcsiion.
1\1 r'0 rnaill- si,lc cflects, to rl,':rl s itl tlr,' "vcr-irrnrcasinS Tiocgl.r ca al. (5) $'uludled thc eflccis of
rc sinnllatcd rlln of slcop di'turl, rrcls. not\ r major ,hcrrn.lrr'P 11,, n,,,\ orr l6 l,.vcLiatric pr-
hcrlth prcblem in groups of all ages. ticnts u lro rcpltscnie(l l1 different diognos-
,l chopathol- In an uncontrolled studl', Roscnthal an(l tit clussifir.ations. Evsluation Drocedures
suggestibil- \\rrlleohn (11) L&vc relorlcd thc r:llctts of ronsisLrtl of clhical clecklist rntings filled
&ltetrrtives clcctrosleep thcrapy oD luticnts rcgistcrcd out l)r' thc l)trticr)t, frien(1 or rcl&ii1'c of
r(lir'c thera- in rl psychiatri( "mcdicxtion clinic." Ss
^
thc plrlirnt, hcatment psyclliatrists, and the
trorc givcn I0 ,lail\ lrc:ilm, lrl. lollor\ing puticDt's rcgular tLcrapist. AdditionaJll',
clinical rttillgs oI onxiety, delrressio11 rnd th. fIIIPI rvas administered l)rior to and
slccp disturbance-s oD lr ?-poiDt sc8lc and Iollo\\ ing tl)o trc&im.Dt-
' slccp, produced bY

neak rhyihmic cnr'

:o-operating subject
ironl))cnt" (2, p. 0),
various clectroslcep
n thc f.-nited Stoist,
bcen used.
rosk,cp research
h85
It Chioaeo Cjrcle, De
x 3438, Chicngo. Illino!
c'lnluation on the Zung Sclf Rrting Dcpres-
sion Scolc. Similar cr':lllatioll procedures
used following trcrtmcnts. Thc initial
'u.rc
trcntment \.as l0 rninutcs iD rluratioll. thc
sccond trcatmoni, 20 ,tiltrrtes, anrl the re-
tn:rining trcaUn,,nr. 30 r i|lu1,.. trollo$.ing
tn&tmont S. t\,r., ulo\\i.l r,r li, ,rrri"rlv or
sht! tor thc rcrrrrirr,L,r' oi r1,,. l-'lrour t,,.-
riod. Thc rcsulbs in.lic{rt0(l illLi, T,Ss hocl
"relatilely totfll rentis-<ior1,, of s],ml)tons, 2
Thc resrrlts i:rdicatcd that slccp symp-
torrs (iui('rnuin) \\ cre rn,rrkodly inr-
pro\.crl" in 7 Ss and "irnlnorc.l" in 4 Ss.
Iile.!s tlirl not cxhiLriL slccp ,.-"-nrytomatol-
og1'. NonsL,cp synptoms (psychological
rlistull)rncr,) lerc "markedll ilrprovcd" in
5 Ss, "inrlrrovtd" in 8 Ss rrd "not im-
plote(l" in 3 Ss. Though no statistical anal-
ysis ol colltrol procedures ncre cmployed, it
rlas coDciurled thf,t a) electroslcep therap]'
110 rdAic !,. wErss

creates an improvemeni in sleep pattcrns rvork by a) usiog a douhle blind procedure

to elimiDatc the possibilitt of effects drrc ing oslet
Jor most peiients with mo(lcrnte or se1-ele
to Ftlrch
slcep sy@pioms; b) sigrilicant in)pr.oYe- suggestioni b) using objectil'e e\.ahatio; '
sonlriA'
me[t oI Donsleep s]'mptoms oltcn occurred |roced[res, llxmcl]'El']G records of the Dft-
concullentl]' \tith the rcliel of sltcp sl'mp- xn,l l,o-t-trcrtnlcnr..l.1.lr; and c)_ I.iIg lhc "r.lirnir
toms, and c) a closc (lcpendcnce of lhc PA- r.r.ronrrrrcrrh.l rltntln r iltd ,lisllilrrrli6n Qllcstlol
o1 nlnl ' sJ
tient, on the operator occulrcd. t, catrront.",
sNl to
It strorrld te noro,l tlr:rt .trr'li,': rNirrq ttblisht
nEG neasurements n-- orrtcouu' critctit Illcncl'
have noi as Jtt l)cen lrl)orterl, \tcreas Tlrc Io)loning L1;xrtlrr:c.. \rcrc iDl,csti-
EIIC nlcasurcDcrts dluing tr.&tmclt l)ayc grrtcrl: if olcctro-rlcep is trul] t!l cffccti\.(
brcn rcl,oued t7, 91. ll.rc UEC tracing" thclxlx.utic l)roccdur( rLl thc latcncics q1
tr,rriinl
rclenle,l tIat, slccl) t)oicntials did nol ap- slocl) onsct in l)ost-trcutr)reltt slccl) Dtttcln$
shorrkl bc significantlv rliffr,rcnt flonr thosc tlc nlol
peal inrmediately nt tre[tncnt ousei. Ilr 13 ortto!.i'
recordirrgs the first slecf poteDtirls eP- latc|cics lound ill tl)c l)rrrlolitDrent slccl)
ts flrlal
pealed rvithir 5 to 10 minrttes aDcl in th(' 3 l)rtt(,rns o[ ])col)lc sullc ng lroln slccl) ousci
lr-\cd al
rcDrrining recordings a{t,er 10 miru[es. ]n irrsourlil. llorc spccifical11, tIe post-treat-
$ltosc
ar) unLlcs(ribed control grolrp, slccp pot(rl- Ilrort lxt(lrcics of thosc S-. r'cccivirrg tht fu-
n'lch s
tials al)pcrrccl 5 to l0 minutcs cller tLc turl trentnrcnt shouLl l,c sigl)ilican J stngo 4
sr:lrt irrg rrcurclings arr,l aftnr I0 minutcs jn .lrorl, r lhxrr ihcir l,r.trc:rlrn.nt lxrcncicr.
Ilcrl ns
l0 rrcordiugs. In a frcqrrcncy comparison of No sigrrificart rlillcrrncc lx'i\\'ccn thc prc-
strrd)'.
l.lE(l strtes during trcatnlort, dccp slecp ir,l l,o.l .lr,.xlrll.r,] l:,lorrci,. .l,orll,l L,,o\i-
rlcrr(,r,rl lol tIosc ,\s rccci!irrg thc sinlulfltcd
Irltto[r! \\'elc not obsel\'cd, rvhcreis st&ge tlc tctt
I-REII i\'&s tlre most frequeDtl) obsen'ed- n1,rtn)r,nt. Ll A follo\\'-rrI t(,rt r)radc to a!-
sturly r
.\rlrlitionxtl)', t|c EEG iraciDgs shoNed tlrat, lcss tlrc staLilit! of thc oll(,ct (rf clectroslcclr
l)ntir'llts' statcments of havir)g siept corrc- tlrc|[1rv should sho{' :r rrlinlonrnco of i]lis
l:rtl,rl sigrrificantly better' \yith obioctiYe c[fc(,t olrr iL o-trcalm(nt Iollow-up illicr. An.
y&1. Finolll', c) il would I)e (,rlxrctcd tlnl
dlrtt tirru strtements of nol,lraviDg slcpt. thc elc
Irr ccnsidering thi-" brief survcy of elcc- thc oLjcoti\f irrrprovcDrcnt lrrrrlicted in Iy- rcl Bcr
troslcel) literature, it seems apparcnt thst potlrcscs l and b coukl l;c acc,rrrtpanicd by n
I,lltc I
rDJ further invesiigatioD of ihe cffects oI (onfirnlatorJ' -.ignificart clrrrrrge in tirc positio
,.cr r','sloc1, rl,.rapy musl ,1.01 \(irlr lhp in- suLjoctil'c slccl) rcl)orts of tllosc,Ss pllrtici' constr
nclerlrurcir:s of prcvious research, p:rrticu- t)atirrg ir tLe actual trertln(rrt condition.
luly t[c hck ol proper control and evalua- Corv('rscll', iI a) tlrcrc i-. a significrntr
tion ploccdures. There is tLe question oI the charrgc iD the slecp l)attcrDs ol Lolrr Ulc ac- Subj
aurDh|r of treatmcnts neccssary to show an tual nnd simulated trcstmcrri groups, in of t$o
cffcct. lt has been rceently comlnented that "objccti\r" placcbo c,flcct \\'ill hove bccn di[ions
ole(troile(p rnay not l)c bettcficial if less substantiated; b) thcrc is no signi6c[nt ulrtcd
thlln 20 treatments are uscd cnd th:tt thcse chrngc in the llosl-trcatmrnt ".locl) pattcrns, blcs ir
cllccts arc cumul&tiye end thus sltould be but there is a significa t i hrDgc ilr tle ucA!ll
rno[e pronounced und(,x Insssed prflctice subjcctive rcports of l,,of,t tlrc tctual and rDd si
conrlitions.2 These t$'o addition&l consider- simulote{l troolmcnt grou|s, a 'subjectivc" hrctr
atiol]s hxve not been invcstigated il) the ex- placeLo effcct rvill bc substrntirted. n|).'I
isting literaturc. fron .
IIEAHOD
l'he researclr ptesenicd hele l)us bccD de- slccD ,

signcd to avoid lhe inadequacir " of l,rcrious

SUBJEClS tfic fi
iA Locsl lreNspaper advertising Nas used h Nhich
personal communication lrctrl Jack Sn)der,
Roche PharmEccutical ComDxnr. solicit pcople $ho havc chroric trotble lall uetho
 TBEA]!IE^"T Of INSoMNIA BI ELECTRoSLDEP 111

,^^^ /inson:nic"'l 1o Inrticll,atc

jn re- terrrs of DerceDtage of total sleep time
iIllT"'"tiJ;tlT speDt iD each sle€p stage nnd the Dercentage
,lecllve e\'Illlation H{Il.;l;llt n:l
:',ii:,r' :'#1,:il J T of total becl lime Ss rrcrc &\\_akc.
Iecoros 0l thc tom''i-]il' quo.riorr,nirp (sl{tslr 'fivo control pr'oc€dures l\'erc intloduced.
Dto.
'; aDd c) tsingthc
"i*' to trroir' nor- Fir-.t. ihlough the iufolmrtion obt:rined
t*]llill;u.'il',"'"irrirrg
v"l" -r^". I'rbit.. lhls ll,lorrnlllon was from Slccp Questionnsirc 1 it \\'is po,csible
n( (llstubrltion ol
""', ,l'..i"a tiros, rrirlr I 'rrbipciir-elr es- to schedule treatDrents in a frsllio that
I'j[i,i.a i".o^r;,' th,'., ul'nic lctrortc'l Noulrl ste:rrlal'dizc thc ttclltrnent-l)ost-treat-
i",.*r' ro .tn"t, urri{ $1' {jU lnll)rltcs ol' rner)t intelral, tLul is, thc l:rsi clcctloslcep
(!.- \'cre inrNr l.i^,.. t,*.t 3 rirrroJ :r \\'r'k Ti rr lolrrn- trcntnro t \\':1,. arlmil1istr,r'ccl to AU,Ss 10
r rty rn cnc4ili ^r rrtrr'lu'rrl: Il:rnlrfo- hoLrrs priol to th.il'rel)orte{l bcd iiurc as
r tlr,, htcncis ol
11'1..
"..n rt,,,relrirn,l r,' '"lc'r''l'
r,rl 3 rriElrtr lor indicntcd o[ this questior]nrile.
ilrij"is "^. 't, Sircc ii \\'rs lcxioDe(l thrt a standaldized
ncnt slccp prttcrD! ]i.,1oniro.ing of lri' 'l' cf in tlrr' sI" l' lnl'
.if:li,r.cnt, froln fllosc
.,nto,y. tlt. 6rst 2 rritlrr'
tr'''rn cnr''i'l'r"l l$alicning litnc, l)c.l tinre, or {imount of
I'r, lrertmlnt slcql niglrt'. 'l lrc rlrirrl .oiiion \\'ns sloc| rould exterr(l or rcsfrict 3s' "notmal"
i. n,larrtnlion
ng lrom slce| onsct
,,.",t n. ,t,n l.rrs lin' ["r'
rll ss Tlro'n Ss slecl) l)rtk lns and thus I)roducc expelirnen-
ll\'. the post-treat. *hns" rcco.ds irr,li',rr'"1 Il,3l
rl,n!Ii'l no{ t^l rrliifrcts (Rl,)ll dcprivaiion, REI\{ sa-
ii li{,ciYing thc tc- rrech s(ng.2 s1.1, si'hirr 20 rnitrrrtc. cn,l tilltjoD eI..) \\')rirh coulrl conlound l)ost-
lrc significan y sinq" e slcct' u itl,in 6n Inir,rr" '
rrr'r" clr."i- trrximcnL r( snlis, ,Ss Ncro alloNed io Iollow
rcrrtruent latelcies.
lic,i os insomnirr,s en'l currtinrrerl io thr' thcir' "norl)l{rl" slcep )rtl;its.'l'l)us, stand-
I hrt\1.cen thc Ec- stu,ll. Ss rrIo frril, l lo rn,nt lLi" cril.rinn ardizntion $xs lot cmploytd bctrvecn iSs,
rcios should bc qi- ).ry a rnndom sclectiorr from brrt \'ns onrployetl \\'ithin Ss to insure com-
r.crc rcplaced
i!ing thc simulstr{ tlc rcmcining Ss. At thc cornpletion oI thc pllr'lttiIe accuracy of t}e rcpcAted measures.
)I l(,rt mldc to at" slrdy cach S l'ns pairl 2i rlollnrs Sccond, "l-rlind" pro('crhrrcs \!ere eln-
'ffrcl. of clcctroslccp plo) erl througlout this lc,.crrch. A double
nairicnauce of tlh bliDrl trealrnent procedure $rs employed
rt lirllorv-up inter- An ltrlectrodonn I \r'. uscd to l)roducc s'lik, MG recolds $ ere scored "blirdly."
d lx, cxpected tlixt thc clectrosleep treatrncnt-". -{n eight_chan-
,rt l)rrdiclcd in |y- IIIO(]I]DIiIID
lclBeckman Dynogrrrph lvas used to record
e acr'(n)rpinied bY I Illrc pattcrns. A Centrallab, PA 4001, 23 l.:rclr rnlrrntnor cotnp)c{etl - r1ttc.{ionnaire
t clrLlge in thc
losition rotary $\\'itcli r'\'as crnployed in thc
(Slecp Qucstionoaire 2) Frtainjng to his
ol tlrosc Ss putici- construction oI the doitble blind aDp.Irotus. slecl) lrabils {or ihe pr.ccding rvcek, the
'0rtrnrnt condition. Corrrell Irrlcx, arrd thc llltPl. Tlrosc Ss
'e ir x significlnl DESICN
selc{rted v.ore irstructed to refrain Irom
:rrrs r-rf both tiie ac SubjecLs rcrc rsnrloml."" assigncd to one taking aly rnedittiior ol dnrgs during ihe
aLrnort groups, nn oI two experinrcntal condition-.. Tircsc con- course oJ the study.
:ct lill have bccn 'lilions wcrc cl, crroql,tr.xirnnnr r,r),1 sir4-
r'lr Or) thc dey foJlorving the l-rLseline pre-
: is no significant nhtcd trcslmcnr. Tlr(, in,lcl,cnd,"nl varia- ireatnrent pllase, the clectrosleeP trcatmeni
rnt slceD pntterns, blcs in the trlo-wny Analysis $,ith repeated phast-. rvas initiatcd. Thc olecLroslecp stim-
ant <'hangc in tlc mcasules werc: tlpc of ireatment (aciunl uli \r'ere all|lied to the &rea above tLe el-es
oli th{, actual and and simulale,lJ an,l uypc of sleep session (through electrodes resc bling a sleep
rupr, rr "subjectilc" (pretreotment, post-tr(,atmeni, ancl follorv- mask) anrl th{i nal)e of tlle rock. Gduze
bstlntiated. ttf). The main clcpendent variable obtained strips ,<atur^ted $ith $'tter rverc placcd be-
lrom the EEG recorrls uas the letcncy of twoen the clectrodes tud the skin. The
slcep onset in minuter, that is, ihe time to treatnrent phase consistcd of a l,otal ol 24
the first, sleep spindlc or "K" complex, irertments, the first being 5 minutes iD du-
ertisir)g 1Ytl8 used h \rllichever came first, 2-miDute &rtifaci ratiou, tlc second, 10 minutes, and the re-
ohroDic tlouble fsll' method. The EEG records \rcre analyzed in maindcr 15 minutcs in dttration. During thc
112 IIARC F. 1VEISS

first tvo treatments Ss remained quietly in he&tment effecLs 1vere obtained. Afte! l{ lerct
the 6ame position for thc rcmeinder of l,he "off" clays the &s egain slcpt in the laborq. t{ ec
l5-minute period. Treatments rvere admin- tory for 2 successive nights, Here follon.lro .t52)
istered at 8 to l0 hours prior to the Ss nor- effcci.q rere obtaincd. Again Sleep Q16x. fl
mal bed time. At the end of this phase, Ss tiornnire 2 and the Cornell Index wers q4. cicnt
rvere asked to complete a second Sleep miristcrcd. 1I both instances tbe 1s..,4 bct$
Questiorraire 2 nu,l tlu'Colncll lndex. frou tLe 2nd riglrt \ras uscd for thq ,r,. ihc l
The folloNilrg irstructiolls $cre tlsed: po-rcs of :rnal]'si-.. Trbl
"You are to lie qtietll' during the treat- -{t tl)c complctior of tLc cxpcrimqn6.l
rnent. Sholtll', as thc cu ent, is iDcreased, Ss r\crc infornrr,cl of thc purpose of this in-
you wi)l fecl i tingling or prickling sensa- vostigaiion. Thosc T\'bo l)atii(ipated in the Addi
tio ol'er ]'oul cl'es. Report this immedi- simulatcd treatmcrt contlition Nere ofrsmd N&s

atel). \Yhen tlris sensation habiiuatcs or r scrics of clcctroslcep treatmcnts iI they 60 SCOr(

subsides, please repod th&t too. This eensa- cltsilcd. Trvo of thc 5 Ss rcquc-.ted 10 "lcgit. tohl
tior is necesssrJ' to determiDe the ploper ilnatc" trcetDlcrts. Icitl
Drachine scttiugs. Iinally, you will bc re_ simtr
quircd to report ADd descrih nny visuol im- sconlrc cltITEIu.{. in bt
agcly and or sensnl ionr ilat you e\perience 'l'hc EEG records r.ere scorcd by ihc cri- rrc
in group grccl
duliDg the treatment." Orrc S each teliu outliled by llechtschnffcu and I(aleg
0gy.
Iound ii mole comfortablc to sit rather than (r0).
lie dosn. l.hol(
disot
Afier the tingling sensation rxa,s repo(ed, TIDSULTS
11
ihe following proce(lures wcre condttctcd: TTtE.l.ItEAlMENI' SLI'EP IIIiASI'IIIIS
a) the output culrcnt o{ thc Eiectrodorm I ofl
n'as increased 0.1 rnA; b) a cover \tas To determine if any initial group dif- s[o!
placed over tlrc output meter to guard lerences cxisted on slcep rncasrrtes, all prc-
agoinst E secilg a changc in ouiput x'iih iro&tment sleep mc&sures for tle actual ond
cD8

the institution of urc double b)ind proce- tlrc simulated treatment groups \vere com- hibi{

tlurc; and c) { rot3{'switch on a separ&te parcd through the usc oI ihe lrlmn Wltitney
contlol box \ras rolatcd. This s$itch wss I/ tcst. No signiflca,nt diffcrcnccs rvere found
ro{urn,l lo a 1,r'c,lnlornircd Jro.ition lposi- bctwccn groups on any oI the lretreatmcnl
(p
tioD 2-23) $hi(h had becn previously 6up- objcciiye or sulJjective slecp mcasures >
plicd to ,8. Of tl)e 23 tottl positions only the 05)
fir'st w:rs knoNn by -E to bc "live," tllrt is,
PRE,I&EATI|IENT PERSONALITY.
position 1 was uscd only cluring ihc iniiial
PSI'OIIOPAf IIOLOCY MEASUR]IS
"adjustment" pcliod. Of the remaining 22
positions 6 \rerc "li1'e" and ryould continue To detcrmine if groups diffclcd in'iprcs'
th. trcnlmert, \'ln,rcrs thc tcmaining l'osi- cncc" or' "dcgree" of psychopnthology, Cor'
tions tcrminaLc.l tLc current, &nd Icsultcd in noll In(lcx scores (see Table 6) *'ere scorcd
a simulated trcotment. Po$itions were prc- in accordance rvith mcthod IJ of thc Comell
nircd lithout Z's knollledge. Siuce S Index mrnual, disi butcd to i 2 x 2 co0'
adnl)ts io the "adjustmcnt" tingle verl' tingcncy tablc, and analyzcd tlrrough the
quickly, neiihcl E nor 3 can diffcrcntiate usc of Fishcr's exa,ct probtbiliiy test,
bctvcen acturl &nd 6imuloted trcatmeni Mcthod B uses a cut-off score ol 13
aftcr lhis "tinglc" period. Through the usc of Sicgcl's (14) iables, no
Tcn hours lolloring tltc list trc&tmeDt, significant diffcrcnce between groups \r'as
Ss \-ere monitored duriDg their night-time lound (p > .05). Additionally, the Modt rI
.1
slccp on 2 successir.e nights. Hclc post- lvhiincy U tesL revealed no significant dif'
 TRDATMENT OF INSOMNIA BT EI,ECTEOSIEEP 113

-" i,' Corn.ll Itr'ler ralt scorcs be_ use of Siegel's (14) iables, no Eignificont
obtained. Altcr
srorrlJ rI' = 4 5 0e6 < P < dilierence betNccn gloups l\'Rs JouDd (p >
slerrt in thc hi;{1ir [#;1]';i"; .05). ^{ filrther anall-sis n'as conducted on
glrts. Here Iollo\.; 't5|1,.,r.orno,, Rirrli.corrcl0rion..( ocm- tbc l.arious subscales of the lItr{PI. Table 1
.A.gain Sleep
Q6i no'isrri,6clnt rclniionrl'ip irdicated that, iluouglr the use of the r\Iann
rnell Inrlcx \.ers ..ni-r"iu"tnA
rr,. (-nrr,nll tbrlu\ m\\ :cotcs rllrrl \\'hilncl tcchniquc, gtoups difieled on the
thc rccod
q6.
""' -
'tAnces- Tj'1,','"x;;,,,;,' l.tcn' r' or slccp orr'nr t'ec Pd lpsl'chopathic tlevirte), Sc (schizophle-
Ls uscd lor thc pur.
I
[',],,1" zt i, ,t'" 0crtrrl
lrci+rrrnrrt grorrp rr' lia), anrl lla (hvporlanie) scale,r. In exch
,f ihc cxDcri cnt ltl l-;"Or, in tl'" sinrrrl:tl.,l lrrrrim'rri grorl' inltrrlce thc sinNrlatcd treatll)ent group ex-
,c purposc ol tlis i6 , I = .:OO), nra in I'orh arorrl' i/, = lsR) )rilritld rL higlrcl rr.rLn'f s(orc. 1'hrough the
Ii,titlor"ltl , no "iJrnili'xr,r r" lLrtions)'ip u"c of Fislrcr''s test, thcsc scorcs lere then
r l)arlicipatcd in the Ind'\ tclt cllluated iol groul) diffetences in "pres-
)rrdiiioD \ticre ollqcd oil forlrd l-,"1s",,, Corn'll rccrr{xA" |rrrr"'of Dsyc]ropatho)ogy. T scores ahor'c 70
...*. L,,d tl," l'l'lrorllrr'lrl l" of
trcstmcrts if thc]. so ; f:'l'l' 3) il tIo rrr,r'c rrsorl as cut-off scorcs. On all lour
L rcqrestcd 10 "lcgit. ,"ial lrcd tirn" asakc tsoo
_- 800, irr tlrc
.nrrrnl trnr,itrront lrro'll' rrs sclLlcs, .rignificant dillercnces bet$cen
tleatrnolrr gr" ll' { r" - .300 r ' nnd g: ou1rs strc not found (p > .05). Therefole,

in l'orlr grorrl,r {r. '

crr scored b]' thc cd-
I
lrr.chrffctr rnrl I{alcs
UI,'IS
oy irjtiol goup dil
(l) mc^s 1(f, &ll pn.
for the actual ond
rucs
cnl, grctlps lvclc (om.
r ol the Monn lVhiineY
rlili'rellccs verc lound
T
"ilruletr'd .381) TIruJ lhi' rnp^'- tlrorrglr a statistical birs did cxist ou Pd, Sc
rrn, indicntcs no pIo'r1' ,lilhrcr r,. irr ",ln- eurl llrL, this \frs not, interlretcd {Is a cli?ri-
scc" nnd/ot '1'lo.'rrr, " of ;,s1cho1,:rtJrnl_
c(rllU,.ignilicrlDt fi n(liug.
;rt. l.ulrhcrmorc. "lnqlce',-rI't'.1 clrul',1- lruIT{E\T Ef DTCTS-SLItEP }IDASInES
rliology" ttos not rnl",
n'l to' rl grce",rf slpoP
disorder. To tcsi. lrypothescs a and L, the Friedman
fhe Ir{tr{PI wns aralyzed through thc usc 'l'\\'o-11ia)'Anal)'sis o{ Yariance by Ranks
of I'isher's exacl. probrhilitl' tc-.t. T scoles l rrs cmplol crl to anrl] ze t|c prctrcaimcnt,
!bc!o 70 \ycre usoll as cut-ofl scores, One oI l)osl-trootDrcnt, and Iollorv-up mcasutcs.
5 Ss in tle actual treAtnt.Dt grotlp llnd 4 oI TaLles 2-4 illrlicate that or tlre basis of
5 Ss in l,hc simulatecl tlcatnnjnL groLrp ex- DI,IG xr(,rLsure6 the rctu:rl treatment group
liLitcd these e]evrttc{l l'srorcs. ThrougL thc e-xhibitcd a significant decline in time to
TABL]i ]

Prctruatrk t lI l'I'l's@,eslot Sdnal u d Si' \latel'l't.ot1tu t C,a ps

nJ ol the l)retrcotmcnl
'r'slcep nrctsurcs (P >

rorqrs dif{cled in 'rPrc's'

CoI'
t'\,'lLUt,rrthologY,
, 'l'rl,le 6t l'erc scord
u lho(l B of ihe Cornell
ihulotl to t2 x 2con'
lxnrlvz(l through tho
,rrlt lrol-rabilitY tesi'
, crrt_olT score ol 13
Sio,Icl's (14) tables, no
rc Lrt\rfuD grouPs $os Rrsire m Dr,ri,t.I *'t
: !E nlr.$rt'bte L,r rt'ksdrr
,\thhiiulrrlh , the Mann 'u6
,,,11,,1 lo significani dil' i
114 MANC I', I\'EISS

6leep onset (latenc)'), percent&ge of total
bed time awake, and perceDt{ge o{ total
sleep time in stage 1 sleep. Though a signif-
i(ant increase vas elidenced in percentagc
T,IBI,IJ
EEG Laten.iei o! Sleep O sct
Pfttr.atrrc t, Po*l1rcatNttl, d
|'olht tp lvco' r.ncrl
cr@n . n* l,*,
oI total sleep time in stage 4 sleep, I furth€t
enalysis rcrealcd {r significant increase jI
total delta slecp. This latter analysis $as
performcd to equalize an1' scodng irade.
I
rluacies in diffelcntiating stagc 3 aDd stage
2
i, 4 slcel). Olr sul,iectil'c me8sures, a signiff.
llinntes at
d calt dcclirre i)r rcl)orted tirnc to slecp q05.1
(latcnct') r\as rcpolted by thc actual trcq1-
Drer)t groul) (TsLlc 51. No significanl dil-

Acr,nl i
l--.- fercrrces $'cr.c cxtribiterl l))' thc simulatcd
trt,atlncnt group.
i

J 100.5 I 12 0 5.0 tREATTIE :\..:t ul' l-DcTs- PEBsof,_nll rr''-

2 80 5 lt.o 100
PSr''CHoPATIIOLO(iI-IIEASCRES
{i 65.5 I 16.0 8.5
? 3J5l 3.0 2.n l'Ln FIi,drrtr,r. T\'o-\\-ry Analysis ot
8 I 2.r.0 8.0 5.5
I I 60.8 lo rj 6.2 Iariancc b1' RrL|ks lvus enrployed to rna.
rr' : to.oo lj'zo thc prctrcntmcnt, post-trl'atment, and
l_-__l
simrrl^t.d I
?= -ooo77
follolY-ul) )ncn-"urcs ol thc Cornell Indcx.
Ifor totol Correll IDdcx scores ro significanl,
Lreat I L difrcrencc rvas found for cithcr the aciital
n,eDt 3166.0 l2r.o 37.0 (x,1 '- l.30. .522 < p < .691, or thc sir r.
J I 73.0 r'!, 0 {5.0
5 I :t7-5 27 0 il 5 latecl tre:rhnent group (x?! = 0.70, -691 <
I I 5r.0 81.0 2t _0 p < .954) (Tet)le 6). Corrcctcd Corncll In-
It) I 75.0 llLO a20 dex scor'cs yielded sinilar no signific{rnt rc-
i I oo5 588 350
xr, : i.2O sults for thc actual trcatment (xr! = 3.10,
p - .093 .182 < p < .367) and the simulated trcet-
mcDt groul) (1r: = 0.10, .954 < p < 1.00)
' TABLti 3 (Tablc 6). 'fhis latter analysis ouritted
Pet & aJ I'otal Den li tc Abake at Prctrcltmeltt, "D0 you oftcn li&ve difEculty
qucsLions 29
l\st-trcdLneht, aul Follou-Lp tleasvenvnt in fal)ing osloqr?" and 65 "l)o you fre-
c,ouD lsl".. qucntly gct ulr tircd in thc lDorning?". It
".'"1 rras rcesoncd thal a larialiorr ln theso in.
---tl-
Acturl
trcot-
I
l
2{ 46 2.51
I

067
somnia-rolulcd qucstions conld conlound
thc gcncral'!)s),ctrologic&l disturbancc"
2 t7 _vl 25u 2 _47
(i 22.82 11.8.r 7.40
7 0.llr 1.66 0.60 IIELATIOT*SIIIP OF SIBJDCTIVD .{ND OBJDCTIVE
I 25.98 2.3.1 r. l0
\i SLDI'P MEISTRDS

tl 19.33J J t!t2
x/2
p:
2.418
= 10.00
-ooo77
The Spcarmun Itank Corrclation Cocff'
ciFn{ t\'c( rspd i'l ordcr to coml:Lrc various
sin,'rrated I subjectire and obiective (EOC) sletl
r8 18.22
measures. In tl)e actu&l trcatmerlt group tho
3 18. 12.45
4 25.58 25.68 11.46 re)rtionship bct$'ccn the trvo ntoasures ol
16.75 9.20 6.19 time io slcep onset was signifrcaDt at tle
I 6.61 18 05 5.90
prctrcrtrn.nt mcasllre-< (r" = .900, p < .05)
10 r9.3d 27.06 l5 98
(l
x 17 296 t8.500 1t .550 and noDsignificant at the post-trc4tment
r', = 2.80 = .238) &nd Jollow-up measurcs (r, =
P = -gti7
.575). In the simulated treaiment group, sll
 nal Tins lot Sct)?t Skep St&ges Taken ot Pre-Iftotmenl' Porl'.Jealment' atlil Follou-up
'
Sleep
Moasurcmant

in stage 4 rleer
a signific&ntl I 43.42 1.86 t.02
Ihis latter q'i; 2 1.71 1.90 0.55
6 10.62 33.58 7 -99
tlize any scorini
7 6.90
tiating stage g s 1.06 5.40 0.92
8
:live measures, & x 9.700
:
xrz
2.606
7 _60
orted l,ime to slccp p = -o21
)rted bJ the acl,ual
e 5). No ri 1 7 -72 18.07 t4 75
2 26.35 19.23 18.30
ibited by the sin 7.02
6 9.48 10.45
7 21-45 19.60 24. 18
8 10.03 9.00 18 00
s-tEB80tidLlTr- x 15.486 75.270 16.462
IEASUnES xf, = 0_4o
P = .954
Two-l\ray Ane
:B 1la6 employed to & REM+A I 7 .12 18.07 14-75
2 26.35 19.23 18.36
rent. posi.trestlncnt; 6 19.82 10.45 18.91
s on the Comell Ii 7 .45 20.06
21.80
_t8
r8.00
ndex scores no si 8 15 &3
i r8 ?14 17.992 18.840
nd lor eibher the ar xrl = O.40
a p < .691) or the
p : ,9&
oup (1rz = 0.70, .691 40.40 34.58
1
3). Co ecLd Comeil 2 50 72 &.s1 4a 77
similar nouignificani 6 50.11 37.13 42.69
7 48.43 53 -29 48.80
I treatment (xr' = 8 57.26 50.00 47 .04
and the siuulat€d x 45.788 {t -t4o 44.5t)4
xr, = 3.60
'0.10,.954<p?1
Iaiter arelysis
P : .182

you ofien hav€ 1 17 08 20-30 74.57

''and 65 "Do you 2 17.37 19.86
28.85
6 19.41 18.47
'ed in ile uorning?", 15 01 14.45
7 15.05
a variation il
these 8 9.60 26.35
restions could conf x t7.876 16.150
ar, :
20.a16
0.40
,choloercal distur
P : -9'A

1 996 19.37 31.68

UBJXCIIW A}ID 2 7 -61 6.50 72 46
6 0.00 037 1.56
7 5-17 5-97 10.06
8 1.58 13.20 7.05
Rank Conelation
ordcr to compare vari x 4 870 9.082
xr, =
12.5$2
B.4O
:bjeciive (EEG) P :.03S
etual hestment $ouP
1 27.M 3S 67 46-
€n the i,1tr0 measuros 2t.2r 23.97
2
)t was significaDt a,t 6 19.41 18.74 30.4r
20.98 .47
ures (rr = .9{0, P < 7
E 25.85 22.{ 33.40
et ttre post-treaimetrt
low-up roeasures (r,
t 22 746 25.212
xr,:7.60
33.770

atfd heatment group,

":-OA
115
 AABLI.
-Continued
s

72_15 16.60 8.69

Simulated treatmentl 1 3
4 3.65 2.03 1.62
5 1.86 2.11
I 8.88 9.39
3.36
7.S0
2.41
r0 5- 03
x ?. r51 6.648
xr, =
.1.552
5.20
a:
P:093
r€
3 14.53 13.97 2r.96
12.95 stt
4 5.21 t2.20
5 19.54 37.66 13.08 e0l
g 25_13 _91 22.21, t!€
16.12
10
x
28.10
18.562
t7 -67
2t _282 t7 _444
ff
tor
p = .951 po
tht
IiEM + A 3 14.53 t3 97 21. 96
4 ,?8 12.20 12.95 fol
5 19.54 37.66 18.73 tht
I 25 -43 65.96 22.21
17.63
ide
l0 28-10 t7.$7
* n.676 m.492 18.696 lac
xr' = r.60 g0
P - -522
res
4S.60 I 1
3 55.39 58.89
4 n -34 15.?3 56.15 \tit
5 47.41 45.08 37.47
hst
I 51.39 4.87 61.04
50.38 me
10 56.83 58.30
x 47 -672 42.574 50.s24 &
r! =: 0.40 slet
P -954
lst
3 14.38 s.88 14.69 heI
33.85 -67 11.97 at(
5 18.68 7.24 ,1

I 7.08 5.41 1.63

r0 9.88 14.66 age
x 16.774 13.372 9.954 ele(
xt, = 2.80
p : .367 sim
tt:
3 2.93 0.66 5.06 p0r
4 9.38 70.37 17.31
n.97 sorl
5 8.91 8.16
I ,.37 elec
10 0.16 601 19.79 my
x 5.720 9.914 15.470
Xrz : 4.1O bng
.724, < P< sent
rcel
3 17.3r 10.54 19.75
29-
c0I!
4 43. 40.04
5 26- 59 15.40 41.69 "pri
I 14.30 29-78 8.85 necl
10 10.04 20.67 necl
x: 22_294 28. 6
xr, : o_44 F
P = .95,l tneo

3 sod 4
" Delt& sleep is compised of the sum oI steges
116
 TEEATTTEMI OF INSOI[NIA Bv ELEqIROSI]IEP 117
-.------.-......
-."". nretreirlment (r. - .675), post- TABLE 5
Ldte cies oJ Sleep Ons.t in
8. (i9 6e!:''l:i ?'- = .3Jo) and follo\-tr) (r' - Subje.tiDely Repotted
---:_=-i\

le2 {r!ntnFr'" '''_-._- A'^-r (Tables

/.r.-l.t^",2 nnd
nD, 5\
rir '
ll,httes ol Pfttrcattvttt, Post-trcttnvnl, an.)
2 ll ffii.'',,.* non'irnintint Fotlou-lp tle60enle t
7.90
c,ou! i" r* 1".,.
2.1{
{.55! QOILITATM
DATA __l
xrl=520 dr,".. dota nrc of n srlbjc.{irc n3illre and
Actual
p = 003
nontinurlll thlorrgl,oui thc 1 120.0 13.0 10.0
21 96
--l,l"."rort.a
",1i,.o St"np Qrestionniirp 3. Tnblo 7 2 90. o 15.0 20.o
.15.0 5.0 15.0
)ii'lii,,- "n ""n'tv'l'" or theq JIrr xr I'rc-
12 95 6 t
t3.9S 7 60. o 15.0 10. o

trcntrneni,
post-l'cn11nent'.ax'l lollon_lll) 6 150 15.0 r00
16.12 l,".ura,. .Aa onc nnn readil] sec. x lrelld \ 660 11.6 13.0
17 {l{ xr':6.70
x,.! = 0 {0 i"nard tess difhc',tt1 in fclling cslncp is tc- .02.1 < p < .{Ii9
thc a.llrnl trcltment gro'rI. Ftlt-
P = .951
-rtc,i bf
ircDrorc, tl,ey lenorl bping mor' r''nl'd
the
2t 90 Hot(cr'er, in tcrrrr' of
r2.95 intlonhrg mornirrg. 3 600 30.0 30.0
16 ?3 ihcsc sabjert;ue iclor'ls sirrrilrr' tlrorrglr rrot .1 15.0 150
22.2t
idcnti.il, trpnrls ro\\of'd, in'p;outnenl rt
i' 5 20 {l 150 10.0
17 63 9 30.0 30.0 200
18 606 1r.t rel,orted lrJ tLc sim.ll1r.,l trexlmcnL l0 ,15. O 70.o 45.0
1r1 = 1.60 groul:. This, rlr,'rr, clarifics tLc qucstiorrabl' I !10 0 21.0
rc.lllts in ciulicr rasr'ol(lr'
xr, = 1.i,0
.12J <p <.1E2
{9.60 At the complction oI tle sttrdy, all Ss
56 15 {illliD thc actusl treatl]t(xrt group fc]t ilcy
31 4i hnd bclcfited frorD tLc olectroslecp treat_ morc extrcme sens:ltion and lor'!, longer dtl-
6r.0J
50 3E lrcDts. In the simulrttcd treatrneni, grouP 3 rotion of t,ime throughout the "trextment."
50.92E Ss fe,lt thcy had berrefitr{ frorn the clcctto- That iE, on occasion thet' expericncecl sensa-
- 0 .10
xri slccf trettnents, 1 S "henofitcd tlroLrgl) tLc tions to tlle yery end ol thc "trcctment,"
P = 9i! lsL $cck of tr0xlnt,rrl.., lnlt lll.n iolrn tlritrg $h.rcas thc actlal trc&tmrnt group rlid not.
14 69 Ilppcied, it tlirll1't sccnt to gcL 8ny Lcttcr," Of greatcr importencc, tlrr:sc repori,s indi-
11.07
and I S fcli no bcnelits. ccte that the doublc blind proccdurc \!as
1.63 T|l.: Lyl)es ol scr:jllinlrs :'nLl vi- rrl itrr- succcssfully cauied out. Ncithct Z nor Ss
7 -76 dgcry thit $clc 't'xpcriclced" during the rlerc lcally abJc to dillerentiate betl\'cen the
!r 0S'l elcctroslecp "tlcatDlcntl" indi( rtc.l 1.Lat thc two typcs of treatrncnts. This is furthcr
xrt=2il simulatcd trcnilucrl grorrp had r urolc bi- substrtntinfocl l)) thc fact tbet Nhen thc Ss
P - -367 zarte experiencc. l,'ol c\aril)l{), thcl re- irr tl, sir'r'rlr l,,l tri.ulr0,rrr grorln \\'cre in-
5.06 portcd, "no stinelillg todx)', rny hcad n'as formcd tl)tt tllcy ha(l ro[ reccivcd actusl
17.31
27.97 sort ol throbbing;" "I\r realll' dizz]';" "big trcrtrncnts, thcl had difiiculty belicving it
elcciric.hork, lrlrrn lhsl,, rn,l b:rLl fecli'rc in bccnrrse of "allthey felt."
l0 70 my Irouth;" "rr stroDg surge ol l)o\'0r in the Irrfolmaiion lrom Sleep Qucstionlaile 3
15.4?0
:{10 hginning follo*crl Ly thc u"rral prickting to some extent rcveals tho treatrDarrt proc-
"r1
.lZl<p<.182 sensation, liglrt-lrcrrlcdnrss o1l' and oD ... a css. In the sirnulutccl treatment group a
Icnl trip," \yllcrees, the :ictutl trc:ltuer)t marliecl voriability or time to slecp onset
r9.75 ^!s
'!.1 coDmented, "u 11-r: mth oyer the eycballs;" nDd Ss' rcstlulness 1l'as coDtinuoily re-
Jl 69 "prickling sensatiorr on clelids an(l basc of |ortcd. ln t)ro x.tul1l Irc{rIm.nt grorrl, sinri-
l1 8; neck;" "felt ln.ickling on ej'es ind back of )cr r';rriabilitt is cl-o rcPn. but orll dJ'ir)g
25.421
rcck, but, i,heli
it dropped ofl.,' tLc cerly plusc of trelltment-.. IIo1\evcr,
Furthermorc, the Ss in the simulated Tlithin this latter group, at a mc&u of 15.6
P= 954 trcetment group seemed to e*peliencc a, days vari&bilit)' declined sharply.
118 UAEC F. VDISS

TABIE 6
Fo ou'up lledsurement offr
Colnell lttte. S@,es dt Pre\eatne'i, Post-treot Dt.nt' and
sl8
llii
,'dt
Total I l9 12
2 4 0 otll
6 6 6 sio
7 5 6
l
8 t3 1l
I 9.4 70 cti
130 sl.r
p< 00t ol
SiDnrlxted trertmert 3 6 6 for
I 3S clt
5 6 6
tIc
I 5.1 {s
l0 20 18 slcl
I 21.4 23.0 log
070 for
.6S1 < ?< 05{
slcr
13 t2 rnc
0 0 (
5 4
2 5 obl
12 10 cn(
64 62 tet
xr' = 3.l0 ins
.182<'p<.3$7
ma
SimtrlAted trestment 3 4 4 5 coI
.1 42 34
6 5 blc
5 5
I 41 17 Is(
l0 20 l8 16 in
a 22.1 z2.a 220
W}
rr,:0.10
.954<p<1.0m usi
n0
questions) have not been included in thtu conrput8tiotr'
'Questions 20 snd 65 (iusomoia-r€lated It
tle
I]NUSUAI, FINDINGB of slcep onset in
post-treatment latencies
Th
the actusl beatmeni $oup vere signifi' tlt
Four oI 5 Ss in both ihc act.la'l and simu-
cant)y shorier than ihe pretrettrlent laten'
la{.ed lrcalmeDt grorrps revcalcd sleop depri-
cies; b) ihis efect was m&iotained over I
!
vation effects (ambiguous REM) ai least [o-treatment interval; and c) the subjec
thr
once over the 7 laboroiory nighis, Addiiion- ind
tive sleep repo of those Ss changed ac'
ally, 1 S revealed aobigLrous REM charac- cordingly. Furthermue, Do such effects lrerc
iho
terized by sleep spindtes in boih the EEG exhibited by the simulaied iretttrent goup.
gr0
and EOG patterns on three occaeions. This Neither of the placebo hypothesc.' were con'
of
finding suggests that Ss \\'ere "hue" insom- firmed.
Iir
niaes rather than''fttrrctional" insomniacs, Ol prime importance is thaL L" decline in
0n(

rvakefulness, both in amount arl.l jrequeDcXl

inl
as judged by tlre perceDtage oi total bd biti
DISCUSSTON

The three major hypoiheses of this inves- time arvake and numbe! of sPonianeous gr0

tigation were confirmed. Specifically, a) the awakenings, and etage 1 o! "liglrt" sleep \Yls I
 119
'TRE.\'I]ID\T OF INSO}INIA 81" ELECI'BOSI'IJEP

- i-.'^r-. in 'lelrr rl'rimarily T\BTI';

,['"rt)r,";) ';;";i ;1,::..r..1' rr'"' it y a'i.:ln';i,.t7')',i,',.!,i,"r:,."0;,:;';:,:",.i: :' ,"'
. I'trrr^\'e- p..,.,,.;.-..,.,, n...t Ialt^--,.t, tr..t..t
Ito9e l -"""nrrrre, ut,^i.l-1.,
norrr'|r.cl'rrrarl ar'-
tr*l:':i"* rl'ii,l,.r.:t.-nrr.r.l5. ,lI
l2
ddc.p
r'''.t(ri-.ic o. crInrFJ- , ..rJr.,1...,.rdip.,r,\d.d',u.-,,
_ r'''s ..
rrn'" - ln.r,.
0
6
othcr
j'" 1'"
C
rl
7.0
r'ul; ';'r':r
5il$,*r,lru;lillli+:.".,,",",.;
c\idcnrc i,,,,,.,-.,
.",'.',r,t,,'" r'n.ri ,ili r' /., /,',,,'-1,', , r i
rr: = l.ll0 Flccf',-."',,.;lccti\e, l,lrrcl,o efl,rt or ron- i"..:ii,rr,,i;nt.,tri 2 | :
.522<p16n1
6 fl,,llil,*'.,#',i-,#"*1;L;.:imf; lllll;:Llll,ljliii;i"', : I 3

1,
3u
0
rr, r'.'"n""'.111':i1iil"1li,'ll''"'
ii'l'ii,1'."i".r,"*0"'""1:..:Tll:il1l""::.:l o
!,i',
lli.1i'",,,,:,'i'."'ri,. :.r';'rr. i.
,1! 2
f:.,.,.',1,i,..),,.,,,,,
1E
nt'n'',,aLi'' ',:; ,, '., .r 'ri r, 'r'v
lll,-ll .,i :i::,:' \Ld,,ri11.,,r,, :0 I .,
23.0
0.i0
i+ilnr
i]i'ii,. r,n.o"",er,t t:r,"llil*
111: :r::il:
'n 0 l0
.691 < 2< .05'l

12
0 illi'i"io ntr""".."e tlai the res"ults r.c i1,,"
4 xrl_ l'.'lal
,,f,,,,in,a tt"tn
r"orlrr dirf' l'
5
rncc" in rgn. clrroll'rr\,
ol-rollronrlrl,1 ( nnz !1,.,r 7,,"1-
? I;
,
r0
62 i"i,,,ir']9*.1:::l'^:i:,i"":lllii::';"::
on all availablc, infor_ l;::#:i:i1""",".
l;
xr1 =
.182<?<
3.10
i,rsornnia. I{owever, ilTiitJr#ilJ,"il* ;
rnntion nonn ot thn'" r'ptiaLln- rorrlJ I ato -i,,r .
l"i I
,,
"rr 0 u
5 c#"ura.a Ur" final outcomc. These raria- ^. ,
tlli;;1",:;'"'
.
x7
i,ll,.n."Al ,r mrrj rl ''r'rr"..'r'.plevi:1; ,r II rz I
"medicaiion," and participation ii,j.,"i"iy *.t..r
5
11 ,rse
.iu
of slcep
No' v.r)';"br".l
mrr.hed. N:l
I 0 n ?
i6 rrorc \!ell
..rchothcrao, Nere
r,, psychotherapl' rtell "maLched." I1Y i":l*, ]] 9 n
220
xr' = 0.1cr
probability icst rc1'eals
.S54<?<1.000 rusing tr'isher's exacL
lo significant group differenccs (p > ,05) ,rorc s.ggestible or more prone to placebo
It mus'u be further noted that all those in reactiviiy? That is, could ihe simulated
jn thi.s coniprtniion

of sleet) onset io
ilc actual eatment, groirp did improve. brcl,6ncnl ,{oup have been 1".s p.one?
ries
This lss not the case it the simulaLed Thnucl, tl,c area of placebo reactivity ha,s
L group vere signifl'
trcttmcnl group. bcon gilen considcrable attenfioll. liiile in
he pretneaiment lshn'
Though a pretrcetn-rcni staiistical bies on thc *,ay of identilying the placc6o reactor
rlis $aint&ined over i
tlroc Bubscales (Pd, Sc and NIa) seems to hrs bee, uncoveted. Ho1'ever, iherc is
l; and c) ihe subjec' "ume
iDdicele tLat, thc rclatile lclcl of psl'chopa- consursus thxi placebo reactors are signifi-
those 8s chaDged 8t'
thology is higher in the simulated treatment cantly (?, < .05) more anxious thrn non-
re, no such eflects \\er
group, it is dimcult to attribute the outcome
llatsd treatDlent $o!l reaclors. This has been the onl5" replicaied
co!'
oi Uris study to effects of psychopetlology. ffnditg (1, 6, 13, 16-18).
o hYpotheses {'ere
lirst, this bias is not clinical in nature. Sec- ff.itlin tlie research presented her-e iwo
oud, sleep
that t'he decliDs h
ce is depri\lttion cl{ecis *err cxlribited MX{I'I anxiety indices were considered,
thereforr: negsting the possi- trVelsh's (19) anxieiy index (AI) and Tay-
tn Lobh groups,
jimount anti irequenc)'l
of total bed bilily oI fun.bional ilsomnie iri cither lor''s (15) Nlanifest Anxiety Scale (T\IAS)'
crcenL3ae
umler ol slonteneou! i
grouD. Though lo significani differences l'ere
slecp {d linally, is it, possible i]rat one group lras lound bei\Yeen groups on either o{ these tlvo
le 1ot "lighi"
,
I 120

inclices (Table 4), the simulated trcatment

group dicl scolc higlrcl on both- flean -AI T
IUedrcal aud l*IcIiatri. u-'ei ol eleckGle"
DF. I.r!. Slst, 3^'i 100 10l l97l
5. ]iocsler, R. X., ljl.li.- S. [1" Rosers, L.. rod
score for the sinrulxted treatment group \'&s Barga. J. H. A t rllnrnrr], :rudr of rl,e u*
of clnrtro.ltl, rl,cml,\'m tl'D'cll DsIcl,ir\tf;;-
64 52 aDd for thc rttuii treai ent grouP In ?'/," Nzrrotr Ststent a d Ek"d"
srs 42.6o. lft*trr 1'flAS ral seole fol the rer.s. PlcnuDt, \6( York, 1970.
siriulate(l tre11tlDcDt grouP \\-as 24 4 xnd for 6. LisrsDo. L.. NIGtelle.,I., von lelsinser, J. U,
thc rctual trlatnx\lt grouP Nas 11.6 'Ihis
."ii loudu", H Ii..'{. stud] ol,the phccbo
r.rdr{..\m. J.IIed-.lr: 770 7?9, 195'1
rtoul,lix(licxr( llr:,( or th. hr.is ol l,r'ctiorr: ?. L".l,u"r. H.. (icr.r. \'. Ptu'1"chelter, C., St.
fiurlillgi thc silnullrtcd treatrnent grouP S.l,u\, Ii.. utll \\ rs'rro'l' r' L M Elcctio"o.
.r1'lrrlogrr1,l,i, :rrril;' ' irt clcclro6lecp. I0
\rould l)c rrorc "pronc'! to Phccbo retctiY- \r;+,r.Ir. l: l\1.. rr'd Sr Scluy, Ii Edr
itl'thrrl th('lrctulrl trcrtrleDi group. If this tlt tt t,,th'.,ttt ,t;' St."r o Elecl'aqk!-
,/., J;a. l':\,"r 1,r,, tl-'ll'1 l:oundor ioo, \c\r
is tllc clrs(,. this lcr:rls furthcr snl)l)ort to
Yorlt.1006.
clrtir'oslcep beiug rtrl clTrcti\'c {tciu&i trcrt_ E. P".l,t, I ii,"'ll;'",'IkP-n rs nad l'"bcl ion!
lull'ut rallrcr th&11 lL 1]LrcrLo elleci. (ir:,rr . \\'.. Trnn.. Inl' rr' tlroonl Pul'lirl,';,
Thu,., orll' t$'o xlLornstives ,lPPcrr in thc \.n Yorlt,191?.
9. Piurlsclnll,r. (i.. rn,l Sr' Scl)ur'. fi. llnc n.
drtlr: rl tho ol)tai)lo(l cflects rrc solcl] at-
corhns Drl,uJi it' cl..tfo-ih.l' and cl.oro.
tril)utitl)lc to clo(troslcel); or l)) elccttoslecl) ^'",rt,,..ir.
Ir, \\'ls"nc,l"r. Ir. Il, 0n,l Sr
is lr placcl)o (ltich illtertcts at, sornc lcvel Srl,u\ - Ii.. l'lds. ]qls./folh''are ia Slce1 and
Elccimnn ltaim ltrcerlni Nrcdim [orndr-
nitll I)stchol)&tholog\' Ho${r\'er) thc lntLer ri.n No$ Torh,1966.
is rcgrte(l l)y thc f.rct that thc sirrrrrlLrtcd ro R, ,1,,i,'.,1I( . A.. nnd Iill' .. .\., Eds. A m1c
,rl ol -rrrrrlrrdiz"l "t''i'''los\'. r"Inrqn'!,
troatnn nt groltl) \'rts nlorc plecebo "|r'orrc." rn.t.J6rib!,\"rn ' for .1",1. JJlcs ol l,Lmon
Sircc rve crl notv conclude that cloctro- rul,iccl". l_r,ir, d srir". Puhlic HFslll' S''Bi'!
slc.l, i. , fl, rrir( irr tlr' rrorrmPnt of clrlonic n,,1,1,,ari, ,201, \'i.LinErurr.l)' C lC68'
slo,l, on-nt irrsorrrrris, ir r, maills Iur lurtlrcr I I Rtu, nrl,xl. S. H.. nnd \\ utirol,n. N. L. Elcclo-
.1".r,: A t,Flintitrcrr .omr'rrricrtion' J Nnn
rc-ieaach to dcLerlniDc Nhy it is effectivc lt II,'nl. D,s.. t,i I: I46 15l.l070'
Irrr been sLrggcstcd l)y I(ocgler et ol. (4) l2 Ho!.nrl,rl. S. H., nn'l ltrrlt'"1'rr' N' LFimulll"d Srrdirr
that: xl t col)(litiollirtg l)roccss is Pcrfontrcd of .lnr'rnsl," I, $;rl, idi'' lrnd
rro,,rrr,or,r I'rrr-. Tl,, r kr.. ,9r 120 130.
rl sorrc lcycli or b) tLftt the expLrurltion I970.
lics ir thL dirccl rtrtion ol the electrioity on r3 sl,;;;' ll. C l,l.n:r\in! rl''*Lo rco'r'r'!' J'
thc hl'air. Tbc for rt'r'is irccloudcd Ly the ," P.t.hol-. r,i 205 212, 1C65. t'ods
i N,,"rr;n,,.t'{ .r't ?t lot th? B?'
lDagnitrdc oI tl)c illtelval bet$een the " '"r---r ii;","i s"i',**. Nl.crx\r-Hill, No$ vo*
treatment and bed tirnc and the lstter duc 1956.
to i)re questiouable pcnetraiing poNer of the 15. Tx\ lor. J. x.r"onilit\ { te ol nrnifclt
.I ^ Ai ro i P't.l,ol., {sj 28t2s'
curre11t. Thus, ihough both are question&- 105;1.
ble, pcrlap-. thc lattcr LyPtrtlcsis rDty bc 16. Thor.. W. li Thc lrlr.cbo
Pl,.,r rr,. lJ; 1035, 1962.
thc rrrorc ionrLle.
u. r,i,i,..i". nlii- * , I r.,(ltin '. r. n. rl.o flamho
lllil laRrr\clis '.-d;$ J. M.nt. S.i., 70?: 00-66, IS56
rhcir psvcl'olon'
18. 'r'.,,i". D. S. Pltr,eho. cnd
1. Ileech.r. H.Ii.,r}/,a{r.lnent o! Subjecttr ]te' ,..1 .fi.c|. .1. trl,Ir. S, i., lns j 344J54 ltn/'
spox.r..-. O\iolll UnireNitl Press' N{N York' jndcs aod an rnttr'
19. 11"1'r' c s An altictt
1959.
2. Bolnirt. \f. E. liti! rr0slc.l) as a sl(cp iNltr'rion ",,ii.,i1,,, ,"r;. ror rl,e NIIIPL J' CoLn r'
nrril,od. PsvrLirlr. folllDr,lr I 13, 1969. Psrlhol. r4: 65 72. 1952'
20. lYillians, 11.. L., ard \l'cbL \'. B. sleel
IiPr
3. Iirlo-.. A. Sliep: Plu&nt'su an.l Pdtholosu' (,ry. Chrrk s C TLo'r's. Sl, rEficld Illinor'
J lJ. l,iIIincutl Pl,ilid.lplrii, llCl
1 Iin,!l,r li. It.. Hi,l:.: [1., rnJ ltrr'r. J' 1006. 'De
titol,2

This