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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017
| Contributor Information
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
From the depths of ancient sleep temples to high-tech, modern sleep science labs, sleep—and all that it encompasses—has fascinated medical practitioners; researchers; and more than one god of sleep, from Imhotep to Kleitman. As our understanding of the fundamental functions of sleep develops, read on for some cross-cultural perspective on doctors' approaches to sleep, dreaming, and well-being throughout history.
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
To the (Egyptian) Sleep Temple We Shall Go
In Egypt, sleep medicine is thought to date to around 4000 BCE and seems to have addressed perceptions of sleep as therapy; the interpretation of dreams; and ailments related to sleep, including ways to treat them. "Sleep temples," which Egyptians visited to inspire their dreams with divine advice and receive healing, were built in the third century BCE and are thought to have been dedicated to Imhotep—vizier to the pharaoh Djoser and possibly one of the first Egyptian physicians who was subsequently elevated to the enviable position of god of medicine.[1]
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
Hippocrates and the Diagnostic Tools of the Night
The Hippocratic corpus references sleep in different instances, conceiving of sleep and dreams as diagnostic tools for somatic symptoms and describing a notion of balance in De Victo IV ("On Dreams").[3] Hippocrates seems to have believed that sleep resulted from blood leaving the limbs to travel to the inner regions of the body and considered that dreams were "medical" in origin.[4]
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
Mind Your Step at the Asklepia
From the sixth century BCE, healing temples ("asklepia") sprouted up throughout the Mediterranean. The temples favored a system of therapeutics that included baths; sacrifices; fasting; and, to round out the experience, "enkoimesis"—or sleeping in the temple. With a few snakes thrown in. Asclepius, the god of healing (who seems to have started out as a humble healer), was believed to provide guidance and remedies to worshippers during their sleep.[6]
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
When in Rome: Dispositions and Solo Sleep
As with much of medical practice, perceptions of sleep and dreaming in the Roman empire were inspired by the Greeks. Sleep temples continued to exist. The great Galen, himself of Greek origin, describes the case of a patrician who sought treatment at the sleep temple in Pergamum.[8] There were generally two periods of sleep during the Roman era: night sleep and the midday rest, which tended to take place in different parts of the house. Wealthier Romans slept solo, whereas the less fortunate bedded down in more communal settings. Romans considered sleep deprivation to be harmful to health.[9]
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
'True' or 'False' in the Islamic Golden Age
Avicenna studied sleep and dreaming in Al-Nafs, writing about the differences between "true" and "false" dreams. He envisaged dreams as the creation of the soul, and thought about similarities between dream and prophecy.[11] In "On Sleep," he wrote about the sleep disorders—lethargy, heavy sleep, insomnia, and melancholy—providing proof that the concepts of sleep and dreaming were discussed during the Islamic Golden Age.[12]
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
First Sleep, Second Sleep
The French physician Dr Laurent Joubert seemed to be aware of the effects of sleep on metabolism.[13] In the medieval period and in many rural societies throughout history and worldwide, the night was separated in two periods of sleep, with an interval of 1-2 hours between the first and second sleep that was relatively active and social. In many cases, sleep was a communal enterprise, with families—and frequently animals—sleeping in a shared space, providing warmth; company; and, no doubt, some comic relief during the dark, wee hours of the night.[14,15]
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
Must Get to Bed. Alone. Now.
The fluid nature of sleep was compromised as people moved to cities and began working outside of their homes for long periods during the day. This resulted in the concept of a more fixed block of nighttime sleep—usually 8 hours—and the development of specific spaces for sleep, which were frequently more solitary than they had been in rural settings. Medical and social theories of sleep and rest stressed the importance of rigid sleep patterns; avoidance of naps; and the necessity, for health reasons, of sleeping alone and undisturbed.[15,16]
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
Larks, Owls, and Predispositions
The influential psychiatrist Emil Kraepelin (1856-1926) was interested in the "phenomenology" of sleep. His studies of the stages of sleep and its depths are being rediscovered and appear to resonate with present-day research. Kraepelin was perhaps the first to develop systematic chronotypes based on clinical studies, neuropsychological experiments, and his study of sleep patterns. He concluded that we are disposed to either morning or evening on the basis of cognitive alertness, physical capacity, and sleeping habits.[18]
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
When Sleep Is Guarded by Dreams
The evaluation of sleep and dreams and how they relate to each other switched in a higher gear with the work of Sigmund Freud, who proposed that dreaming protects sleep from disruption. One of the initial foundations of psychoanalysis, Freud's dream model conjectured that dreams are triggered by arousal during sleep and the lack of dreaming causes disruption of sleep.[19] These ideas set the stage for heated debate on how dreams relate to sleep and, more juicily, the place of dreams as the potential keys to the deepest secrets of the mind.[20]
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
The Brain at Sleep
Often considered the father of sleep medicine, Dr Nathaniel Kleitman put sleep on the map with experiments that captured the imagination of mid–20th-century America. He shared his theories on the role of sleep for individuals and society, and differentiated between the influences on sleep of habit and biology.[16] With the establishment of rapid eye movement (REM) as an indicator of mental activity, Kleitman and his fellows William Dement and Eugene Aserinsky revolutionized ideas of the brain "at sleep," establishing that it wasn't merely "turned off," and opening new fields in the study of cognition.[16,21]
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
Sleep for the Wee Baby (Boomer)
The sleep patterns of babies—a vast subject in itself—took center stage in postwar American homes, guided by a trend toward leniency. As expressed in Dr Spock's writings, popular theories veered from rigid sleep schedules, providing space to account for the needs and feelings of each baby. Let baby cry? Or go and soothe baby? The debate raged and goes to show the extent of the perceived importance of sleep and its role in the development of individuals.[15,16]
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
Polyphasic Sleep: Take Two
A new wave of research in the 1980s and 1990s pointed to the polyphasic nature of human sleep. Dr Thomas Wehr proposed the role of photoperiods in influencing sleep patterns, showing in his experiments that individuals slept in two symmetrical patterns interrupted by a waking period of 1-3 hours when the photoperiod was reduced from 16 to 10 hours.[23] Historian Dr A. Roger Ekirch's seminal work, drawing on years of research, also emphasizes segmented sleep in preindustrial societies.[24] This discovery may help identify solutions for sleep dysfunction.[25]
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QD? BID? PRN? Doctors on Sleep Through the Ages
Steven Rourke | May 2, 2017 | Contributor Information
Restoring You and Me
Through the most recent sleep research, we are beginning to understand the critical importance of sleep and its function for the body and mind. Despite advances, sleep retains some of the greatest mysteries in medicine and continues to expand as a discipline and source of popular interest.[26]
From rice-based concoctions to pulque, mystery 'tonics' to the 'green fairy,' alcohol has been prescribed for medicinal purposes since time immemorial. Join us on a bar hop through history.Medscape Features Slideshows, March 2017
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Steven Rourke
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Disclosure: Steven Rourke has disclosed no relevant financial relationships.
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References
Assad T. Sleep in ancient Egypt. In: Chokroverty S, Billiard M, eds. Sleep Medicine: A Comprehensive Guide to Its Development, Milestones, and Advances in Treatment. New York: Springer; 2015.
Nissin L. Roman sleep: sleeping areas and sleeping arrangements in the Roman house [doctoral dissertation]. University of Helsinki, Faculty of Arts, Department of World Cultures, Ancient Languages and Cultures. 2016. https://helda.helsinki.fi/handle/10138/168326 Accessed March 13, 2017.
Duff K. The Secret Life of Sleep. New York: Atria Books; 2014.
Wolf-Meyer MJ. The Slumbering Masses: Sleep, Medicine, and Modern American Life. Minneapolis: University of Minnesota Press; 2012.
Heynick F. Language and Its Disturbances in Dreams. The Pioneering Work of Freud and Kraepelin Updated. New York: John Wiley. 1993
Becker K, Steinberg H, Kluge M. Emil Kraepelin's concepts of the phenomenology and physiology of sleep: the first systematic description of chronotypes. Sleep Med Rev. 2016;27:9-19.
Guénolé F, Marcaggi G, Baleyte JM. Do dreams really guard sleep? Evidence for and against Freud's theory of the basic function of dreaming. Front Psychol. 2013;4:17.
Coren S. Sleep Thieves: An Eye-Opening Exploration Into the Science and Mysteries of Sleep. New York: Free Press; 1996.
The Stanford Center for Sleep Sciences and Medicine. http://sleep.stanford.edu/ Accessed March 18, 2017.
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