Sleep Medicine - History

History

A 16th-century physician wrote that many laborers dozed off exhausted at the start of each night; sexual intercourse with their wives typically occurring in the watching period, after a recuperative first sleep. Anthropologists find that isolated societies without electric light sleep in a variety of patterns; seldom do they resemble our modern habit of sleeping in one single eight-hour bout. Much has been written about dream interpretation, from biblical times to Freud, but sleep itself was historically seen as a passive state of not-awake.

The concept of sleep medicine belongs to the second half of the 20th century. Due to the rapidly increasing knowledge about sleep, including the growth of the research field chronobiology from about 1960 and the discoveries of REM sleep (1952–53) and sleep apnea (first described in the medical literature in 1965), the medical importance of sleep was recognized. The medical community began paying more attention than previously to primary sleep disorders, such as sleep apnea, as well as the role and quality of sleep in other conditions. By the 1970s in the US, and in many western nations within the two following decades, clinics and laboratories devoted to the study of sleep and the treatment of its disorders had been founded. Most sleep doctors were primarily concerned with apnea; some were experts in narcolepsy. There was as yet nothing to restrict the use of the title "sleep doctor," and a need for standards arose.

Basic medical training has paid little attention to sleep problems; according to Benca in her review Diagnosis and Treatment of Chronic Insomnia (2005), most doctors are "not well trained with respect to sleep and sleep disorders," and a survey in 1990–91 of 37 American medical schools showed that sleep and sleep disorders were "covered" in less than two (2) hours of total teaching time, on average. Benca's review cites a 2002 survey by Papp et al. of more than 500 primary care physicians who self-reported their knowledge of sleep disorders as follows: Excellent – 0%; Good – 10%, Fair – 60%; and Poor – 30%. The review of more than 50 studies indicates that both doctors and patients appear reluctant to discuss sleep complaints, in part because of perceptions that treatments for insomnia are ineffective or associated with risks, and:

Also, an editorial in the American College of Chest Physicians' (pulmonologists') journal CHEST in 1999 was quite concerned about the Conundrums in Sleep Medicine. The author, then chair of her organization's Sleep Section, asked "What is required to set up a sleep laboratory? Money and a building! Anyone can open a sleep laboratory, and it seems that just about everyone is." On the accreditation process for sleep laboratories, she continues: "This accreditation, however, is currently not required by most states, or more importantly, by most insurance carriers for reimbursements... There is also an American Board of Sleep Medicine (ABSM) that certifies individuals as sleep specialists. This certification presumably makes those individuals more qualified to run a sleep laboratory; however, the certification is not required to run a laboratory or to read sleep studies." Her concern at the turn of the century was:

In the UK, knowledge of sleep medicine and possibilities for diagnosis and treatment seem to lag. Guardian.co.uk quotes the director of the Imperial College Healthcare Sleep Centre: "One problem is that there has been relatively little training in sleep medicine in this country – certainly there is no structured training for sleep physicians." The Imperial College Healthcare site shows attention to obstructive sleep apnea syndrome (OSA) and very few other disorders, specifically not including insomnia.