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After a short introduction by Otto Fenichel, Emanuel Windholz presents an outline of the multiplicity of problems involved in the neurotic disturbances of sleep and makes some practical suggestions as to how they may be approached. The problem of sleep disturbances is identical with the problem of tension created by a conflict with repressed wishes, because the state of sleep creates a relative weakness of the ego and a relative strength of those wishes. The state of sleep also brings about a regression to the primary narcissism of the suckling. Persons with oral fixations are either inclined to enjoy especially the body feeling of this narcissistic state, or else they have to fight it. The first attitude may lead to a libidinization of sleep and a craving for it; the second attitude, however, creates sleeplessness. In melancholia sleep may have the same significance as eating, and therefore the same conflicts are valid for sleeping as for eating.
Christine Olden presents a report of two cases of neurotic insomnia. Anxiety from repressed infantile fantasies kept the patients under tension. One patient showed such a tremendous castration fear that she could keep it under control only by staying awake. Frances Deri describes a somewhat unusual sleep disturbance: a 'wake-hour' from two to three in the morning, which disappeared after the patient had worked through the 'primal scene' material. Anna Maenchen gives a sketchy outline of the psychoanalytic literature concerning sleep and also some of her own case material.
In a kind of summary Otto Fenichel recapitulates the problem of the neurotic disturbances of sleep as a whole. The impossibility of complete relaxation because of sleep disturbances is connected with a person clinging to certain cathexes. The ego fears the state of sleep because it knows that the repressed impulses will try to become manifest. The curtailment of ego function is feared as a loss of the ego's censorship over the instincts and at