Previous articles have reviewed the behavioral literature and concluded that predictable shock conditions are less aversive than unpredictable shock conditions. This article reviews the literature on predictable and unpredictable shock conditions relative to physiological measures of stressfulness and considers the possible role of stress-induced analgesia in both the physiological and behavioral effects. It finds that unpredictable conditions are physiologically more stressful than predictable conditions when subjects are exposed to them for one or a few sessions and parameters of stress are relatively severe. However, predictable conditions may be more stressful than unpredictable conditions when sessions are long and extend over days and parameters of stress are less severe. The effect of extended stress appears to depend upon the physiological measure used. These findings are discussed in terms of the phasic versus chronic nature of predictable versus unpredictable stress and the organism's ability to adapt physiologically to these conditions. Finally, the data on stress-induced analgesia are reviewed. We conclude that stress-induced analgesia does not significantly contribute to either preference for predictable over unpredictable stress or their differential physiological effects.

Repetitive traumatic dreams remain a curiosity in our working with patients. If dreams have a sleep protecting or problem solving function, the dream that does not resolve but repeats and that disturbs rather than protects sleep remains an important clinical problem. We see in individual patient experiences and in civilian disasters samples of individuals who are unable to return their dream life to a condition in which it no longer repeats or disturbs their sleep. Clearly the recent experience of combat survivors of Vietnam becomes a major concern.

Since earlier descriptions of the syndrome of obstructive sleep apnea (OSA), various treatment alternatives have included a variety of medical regimens, continuous positive airway pressure (CPAP), tracheostomy, and other surgical options. A lack of acceptable criteria for surgical intervention remains an important concern for the surgeon. in an attempt to resolve some of the controversies pertaining to various therapeutic modalities, we performed a retrospective analysis--from 1983 to the present--of posttreatment results in patients who underwent surgical therapy and those who were treated primarily with CPAP at this institution. Of 400 patients diagnosed with OSA, only 66 underwent surgical treatment, including uvulopalatopharyngoplasty. CPAP was the mainstay of treatment in the majority of our patients. Post-treatment data were available for 50 patients treated with CPAP and for 45 patients treated surgically. A comparative analysis of polysomnographic studies revealed superior cures with CPAP, although long-term compliance remains a significant problem. We advocate CPAP as initial therapy in patients with no clinically apparent causes for obstruction (e.g., nasal polyps, deviated nasal septum, or obstructive tonsillar hypertrophy) because of the predictability of success, and lower costs and complication rates. Long-term followup of OSA patients is indicated, regardless of treatment modality.

Three experiments are presented involving behavioral control of sleeping respiration during all‐night sleep recording. Probability and latency of the breathing response to an auditory signal revealed that control over sleeping respiration was obtained in all sleep stages and was maintained over several nights. This control was especially marked when failure to respond was punished (contingency procedure) by increasing the intensity of the signal (Experiments 2 and 3). Few awakenings occurred to the signal but signs of brief arousal (bursts of alpha activity, increases in EMG activity, EEG “speeding”) often accompanied the behavioral response. Overall sleep patterns were only minimally disrupted by the procedure. Demonstrating behavioral control over sleeping respiration may be a promising step toward the development of behavioral therapies for certain sleep apnea disorders and hypoventilation syndromes.