(BQ) Part 1 book Sleep medicine - A comprehensive guide to its development, clinical milestones and advances in treatment presents the following contents: Evolution of sleep medicine by historical periods, sleep medicine from the medieval period to the 19th century, the early evolution of modern sleep medicine,...
Sleep Medicine Sudhansu Chokroverty • Michel Billiard Editors Sleep Medicine A Comprehensive Guide to Its Development, Clinical Milestones, and Advances in Treatment Editors Sudhansu Chokroverty Professor of Neuroscience, Seton Hall University, South Orange, NJ; Clinical Professor of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Director of Sleep Research & Co-Chair emeritus of Neurology, JFK New Jersey Neuroscience Institute, Edison, NJ, US Michel Billiard Honorary Professor of Neurology School of Medicine University Montpellier I Honorary Chair Department of Neurology Gui de Chauliac Hospital Montpellier, France ISBN 978-1-4939-2088-4 ISBN 978-1-4939-2089-1 (eBook) DOI 10.1007/978-1-4939-2089-1 Library of Congress Control Number: 2015936923 Springer New York Heidelberg Dordrecht London © Springer Science+Business Media, LLC 2015 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Preface Sleep medicine is now accepted as an independent medical specialty Therefore, it is important for sleep specialists practicing sleep medicine to know its roots and historical evolution Despite a remarkable progress and development of the field of sleep medicine there are no books whatsoever addressing the evolution of the development of this tremendous endeavor In addition to the need for carefully documenting this fascinating evolution from the rudimentary concepts of the ancient prehistoric and the early classical periods to our contemporary knowledge, it is essential for young sleep clinicians and researchers entering the field to have access to a comprehensive, highly readable account of the evolution of sleep medicine, chosen by these aspiring physicians as their professional career Within the past two decades there has been at least a tenfold increase of volume on sleep disorder textbooks There are now many tens of thousands of individuals involved in clinical sleep medicine and sleep research in addition to an explosion of sleep laboratories and sleep centers worldwide spanning from East to the West and from North to the South along with the growth of national and international sleep societies A new and rapidly emerging field needs its own specialty journals and societies Beginning with the first in the field, the journal Sleep followed by the Journal of Sleep Research and Sleep Medicine, now there are a significant number of journals exclusively devoted to sleep medicine and sleep research both as print and online versions Despite the exponential growth of the field including the number of societies and participants involved, there has been little documentation of its historical development and its challenges until recently Some early books on sleep provide a good account of the historical aspects including the early French volumes “Le Sommeil et les Reves” by Alfred Maury (1861), “Le Probleme Physiologique du Sommeil” (1913) by Henri Pieron, “Le Sommeil” (see the last chapter) by Dr J Lhermitte (1931), and “Les Troubles du Sommeil: Hyersomnies, Insomnies and Parasomnies” by Henri Roger (1932) These were followed by “Sleep and Wakefulness” (1939 and 1963) by Nathaniel Kleitman, “Sleep and Waking” by Ian Oswald (1962), “Le Sommeil de Nuit Normal et Pathologique” edited by Henri Fischgold (1965) and “The Abnormalities of Sleep in Man” edited by Lugaresi et al (1968) Much information of historical interest is also in the volume “Sleep and its Disorders” by J David Parkes (1985) However, all these volumes are either on sleep or sleep disorders in general rather than on the overall historical development of the field There have been a number of historical articles on individual breakthroughs in our understanding of the basic sleep–wake mechanism and discovering new sleep disorders but there are no books on the historical milestones in this fascinating field The time is now not only ripe but overdue to document the remarkable progress on a state approaching rapidly “At Day’s close” (nighttime sleep) in which we spend one third of our existence The purpose of this book is to provide a comprehensive, balanced, fair, and easily readable account of the history of developmental milestones of sleep medicine The book will be of interest not only to individuals working in the field but also the physicians in general As such the book is directed at internists (especially those specializing in pulmonary, cardiovascular, v vi Preface gastrointestinal, renal and endocrine medicine), neurologists, neurosurgeons, family physicians, psychiatrists, psychologists, otolaryngologists, dentists, pediatricians, neuroscientists, as well as those technologists, nurses, and other paraprofessionals with an interest in sleep and its disorders We believe that this book could attract significant interest in the general public as well Sudhansu Chokroverty Michel Billiard Acknowledgements We thank all the contributors for their lucid, scholarly, informative, and eminently readable contributions We also wish to thank all authors, editors, and publishers who granted us permission to reproduce illustrations that were published in other books and journals We are particularly indebted to Gregory Sutorius, editor of Clinical Medicine at Springer Science, New York for his professionalism, thoughtfulness, and for efficiently moving forward various stages of production We must also acknowledge with appreciation the valuable support of Jacob Gallay, developmental editor and all the other staff at the Springer production office for their dedication and care in the making of the book The editors would like to acknowledge Roger Broughton, MD (author of Chap. 29 and co-author of Chap. 11), for encouraging them to write a book on the historical developmental of sleep medicine and in fact some of his thoughts and justifications have been incorporated in this preface SC would also like to acknowledge the splendid help of Samantha Staab and Toni Bacala, editorial assistants to the journal Sleep Medicine for correspondence with the contributors and making appropriate track changes and also Jenny Rodriguez for typing some materials for the book Last but not the least the editors would like to thank their wives Dr Chokroverty expresses his love, appreciation, and gratitude to his wife, Manisha Chokroverty, MD, for inspiring and encouraging him during all stages of production of the book while he had been stealing precious weekends from her for continuing to work in order to finish the book in a timely manner; Dr Billiard expresses his appreciation for his wife, Annick Billiard, for tolerating long hours spent in reviewing all the chapters Sudhansu Chokroverty Michel Billiard vii Contents 1 Introduction��������������������������������������������������������������������������������������������������������������� 1 Sudhansu Chokroverty and Michel Billiard Part I Evolution of Sleep Medicine by Historical Periods 2 Sleep in Ancient Egypt���������������������������������������������������������������������������������������������� 13 Tarek Asaad 3 Sleep Medicine in the Arab Islamic Civilization���������������������������������������������������� 21 Shahira Loza 4 Sleep Medicine in Ancient and Traditional India�������������������������������������������������� 25 V Mohan Kumar 5 Sleep Medicine in Ancient and Traditional China������������������������������������������������� 29 Liu Yanjiao, Wang Yuping, Wang Fang, Yan Xue, Hou Yue and Li Shasha 6 Sleep in the Biblical Period�������������������������������������������������������������������������������������� 35 Sonia Ancoli-Israel 7 Sleep in the New Testament�������������������������������������������������������������������������������������� 43 Michel Billiard 8 The Greco-Roman Period���������������������������������������������������������������������������������������� 47 Joseph Barbera 9 The Aztec, Maya, and Inca Civilizations���������������������������������������������������������������� 55 Edgar S Osuna Part II Sleep Medicine from the Medieval Period to the 19th Century 10 Sleep Medicine in the Middle Ages and the Renaissance������������������������������������ 63 A Roger Ekirch 11 Sleep in the Seventeenth and Eighteenth Centuries�������������������������������������������� 69 Michael Thorpy ix x Contents Part III The Early Evolution of Modern Sleep Medicine 12 The Evolution of Sleep Medicine in the Nineteenth and the Early Twentieth Century������������������������������������������������������ 75 Hartmut Schulz and Piero Salzarulo 13 The History of Polysomnography: Tool of Scientific Discovery����������������������������������������������������������������������������� 91 Max Hirshkowitz Part IV Sleep Medicine Societies, Professional Societies, and Journals 14 A History Behind the Development of Sleep Medicine and Sleep Societies������������������������������������������������������������������������������ 103 Brendon Richard Peters and Christian Guilleminault 15 Development of Sleep Medicine in Europe��������������������������������������� 113 Michel Billiard 16 Evolution of Sleep Medicine in Japan����������������������������������������������� 125 Masako Okawa 17 History of Japanese Clinical Sleep Medicine������������������������������������ 129 Naoko Tachibana 18 Sleep Medicine Around the World (Beyond North American and European Continents, and Japan)��������������������������� 133 Sudhansu Chokroverty Part V Sleep Disorders in Historic Diseases 19 Cholera������������������������������������������������������������������������������������������������� 143 Donatien Moukassa, Obengui and Jean-Rosaire Ibara 20 Encephalitis Lethargica���������������������������������������������������������������������� 149 David Parkes 21 African Sleeping Sickness������������������������������������������������������������������� 159 Alain Buguet, Raymond Cespuglio and Bernard Bouteille 22 Sleep and HIV Disease������������������������������������������������������������������������ 167 Kenneth D Phillips and Mary E Gunther Part VI Historical Milestones of Individual Sleep Disorders 23 Evolution of the Classification of Sleep Disorders��������������������������� 183 Michael Thorpy 24 History of Epidemiological Research in Sleep Medicine����������������� 191 Markku Partinen Contents xi 25 The Insomnias: Historical Evolution������������������������������������������������ 197 Suresh Kumar and Sudhansu Chokroverty Part VII Neurological Sleep Disorders 26 Narcolepsy–Cataplexy Syndrome and Symptomatic Hypersomnia�������������������������������������������������������� 205 Seiji Nishino, Masatoshi Sato, Mari Matsumura and Takashi Kanbayashi 27 Idiopathic Hypersomnia��������������������������������������������������������������������� 223 Sona Nevsimalova 28 Kleine–Levin Syndrome��������������������������������������������������������������������� 229 Michel Billiard 29 Movement Disorders in Sleep������������������������������������������������������������ 237 Sudhansu Chokroverty and Sushanth Bhat 30 History of Restless Legs Syndrome, Recently Named Willis–Ekbom Disease����������������������������������������������������������� 249 Richard P Allen 31 Sleep and Stroke���������������������������������������������������������������������������������� 255 Mark Eric Dyken, Kyoung Bin Im and George B Richerson 32 Sleep in Neurodegenerative Diseases������������������������������������������������ 271 Alex Iranzo and Joan Santamaria 33 Sleep, Cognitive Dysfunction, and Dementia����������������������������������� 285 Stuart J McCarter, Erik K St Louis and Bradley F Boeve 34 Fatal Familial Insomnia and Agrypnia Excitata: Insights into Human Prion Disease Genetics and the Anatomo-Physiology of Wake and Sleep Behaviours���������������������� 301 Elio Lugaresi and Federica Provini 35 Epilepsy and Sleep������������������������������������������������������������������������������ 309 Sándor Beniczky and Peter Wolf 36 Sleep Disorders after Traumatic Brain Injury: Milestones in Perspective������������������������������������������������������������������� 319 Richard J Castriotta and Mark C Wilde 37 Headache Syndromes and Sleep�������������������������������������������������������� 331 Munish Goyal, Niranjan Singh and Pradeep Sahota Part VIII Psychiatric and Psychological Sleep Disorders 38 Depression�������������������������������������������������������������������������������������������� 339 Michelle M Primeau, Joshua Z Tal and Ruth O’Hara 186 DSM of the American Psychiatric Association DSM-II In 1968, in the second American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-II), the only category for sleep disorders was the entry “Disorder of Sleep” [32] DSM-III In DSM-III (1980), the only two disorders of sleep included sleepwalking (somnambulism) and sleep terrors (pavor nocturnus) which were classified in the section entitled “Other Disorders with Physical Manifestations.” DSM-III-R (1987) included an expanded listing of sleep disorders in a separate section entitled “sleep disorders” [33] It included disorders of at least month in duration that were classified into two groups: the dyssomnias and the parasomnias The dyssomnias were defined as disorders where the predominant disturbance is in the amount, quality, or timing of sleep The parasomnias were defined as an abnormal event occurring during sleep The categories were determined by interrater reliability using a structured interview The dyssomnias consisted of three main disorders: insomnia disorder, hypersomnia disorder, and sleep–wake schedule disorder The parasomnias consisted of: nightmare disorder, sleep terror disorder, and sleepwalking disorder The revision of the American Psychiatric Association’s DSM-III was under way when the ICSD was in development in the late 1980s DSM-III-R contained an abbreviated list of sleep disorders that served the purposes of the overall DSMIII-R classification but was not compatible with the ICSD DSM-IV The DSM-IV, published in 1994, included additional sleep disorders in part based on the ICSD (Table 23.3) [34] A major section entitled “Primary Disorders” included Table 23.3 DSM-IV (1994) M Thorpy in the dyssomnia category: primary insomnia, primary hypersomnia, narcolepsy, breathing-related sleep disorders, and circadian rhythm sleep disorder Another category under parasomnias lists: nightmare disorder, sleep terror disorder, and sleepwalking disorder, as in DSM-III-R A second major section listed “sleep disorders related to another mental disorder,” and there was an “other sleep disorders” category The process of revising the DSM-IV to produce DSM-V was initiated in 2010 and was implemented in 2010 Diagnostic Classification of Sleep and Arousal Disorders The Association of Sleep Disorder Centers (ASDC) classification committee, chaired by Howard Roffwarg, produced the DCSAD in 1979 It ushered in the modern era of sleep diagnoses and became the first classification to be widely used internationally (Table 23.4) [22] The classification was produced by both the ASDC and the Association for the Psychophysiological Study of Sleep (APSS) and was published in the journal Sleep The development of DCSAD began with a workshop on “Nosology and nomenclature of the sleep disorders” in 1972 at the APSS annual meeting The DCSAD classification consisted of four major categories: (A) the Disorders of Initiating and Maintaining Sleep (DIMS), (B) the Disorders of Excessive Somnolence (DOES), (C) the Disorders of the Sleep-Wake Schedule (DSWS), and (D) the Parasomnias The first two categories were more of a differential diagnosis listing However, some disorders, such as the sleep-related breathing disorders, could produce symptoms of both insomnia and excessive sleepiness, and the circadian rhythm sleep disorders could produce both symptoms Many disorders were listed twice, once in each symptom category The parasomnia listing was long and did not have subcategory organization By the mid 1980s, a revised classification system was needed Primary sleep disorders Dyssomnias Primary insomnia Primary hypersomnia Narcolepsy Breathing-related sleep disorder Circadian rhythm sleep disorder Dyssomnias NOS Parasomnias Nightmare disorder Sleep terror disorder Sleepwalking disorder Parasomnia NOS Sleep disorders related to another mental disorder Secondary sleep disorders due to an axis III condition Substance-induced sleep disorders DSM diagnostic and statistical manual, NOS not otherwise specified Table 23.4 DCSAD outline (1979) (A) Disorders of initiating and maintaining sleep (B) Disorders of excessive somnolence (C) Disorders of the sleep–wake schedule (D) Parasomnias DCSAD diagnostic classification of sleep and arousal disorders 23 Evolution of the Classification of Sleep Disorders The International Classification of Sleep Disorders ICSD-I The ICSD, produced by the American Sleep Disorders Association in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society, was developed as a revision and update of the DCSAD (Table 23.5) [35] This revision was necessitated by the description of many new disorders and the further development of information on many of the originally described disorders Classifying the disorders by pathophysiological mechanism was preferred The ASDC initiated the process of revising the DCSAD classification in 1985 by establishing an 18-member Diagnostic Classification Steering Committee under the chairmanship of Michael Thorpy The first meeting of this group was convened in July 1985 at the Annual Meeting of the ASDC in Seattle A detailed questionnaire was developed and distributed to members of the Clinical Sleep Society (CSS) in the USA and to sleep specialists around the world to determine the usefulness of the first edition of the classification and to assess the potential usefulness of a number of proposed changes Members representing the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society and the Clinical Sleep Society were involved in the ICSD development of the individual disorders Every entry in the DCSAD was assessed for content and relevance in the practice of sleep disorders medicine The questionnaire respondents regarded the original classification highly and the majority of the individual diagnostic entities were considered appropriate and relevant to clinical practice However, opinions differed on both the overall classification structure and some of the individual diagnostic entries Table 23.5 ICSD-1 outline (1990) (1) Dyssomnias Intrinsic sleep disorders Extrinsic sleep disorders Circadian rhythm sleep disorders (2) Parasomnias Arousal disorders Sleep–wake transition disorders Parasomnias usually associated with REM sleep Other parasomnias (3) Medical/psychiatric sleep disorders Associated with mental disorders Associated with neurological disorders Associated with other medical disorders (4) Proposed sleep disorders ICSD international classification of sleep disorders, REM rapid eye movement 187 Of the four main DCSAD diagnostic categories, section (C), “the Disorders of the Sleep–Wake Schedule,” now called the “Circadian Rhythm Sleep Disorders,” was the most favored grouping, probably because of its pathophysiological consistency due to the underlying chronophysiological basis The survey indicated that clinicians required more diagnostic information about respiratory and neurological disorders, so those sections were expanded In addition, integration of childhood sleep disorders into the overall classification system was recommended A separate childhood sleep disorders classification was considered, but this may have produced an artificial distinction between the same disorder in different age groups A classification for statistical and epidemiological purposes required that each disorder be listed only once Organization on the basis of symptomatology was unsatisfactory because many disorders could produce more than one sleeprelated symptom The final structure was organized more pathophysiologically and less symptomatically However, as the pathology is unknown for the majority of the sleep disorders, the classification was organized, in part, on physiological features: a pathophysiological organization The ICSD-I grouped the sleep disorders into four major sections Section (1), the dyssomnias, included those disorders that produced a complaint of insomnia or excessive sleepiness The dyssomnias were further subdivided, in part along pathophysiological lines, into the intrinsic, extrinsic, and circadian rhythm sleep disorders Section (2), the parasomnias, included those disorders that intruded into or occurred during sleep but did not produce a primary complaint of insomnia or excessive sleepiness Section (3) was the medical/psychiatric sleep disorders Section (4) comprised the proposed sleep disorders, developed in recognition of the new and rapid advances in sleep disorders medicine New disorders were being discovered, and some questionable sleep disorders had been more clearly described The inclusion of these disorders encouraged further research to determine whether they were specific disorders in their own right or whether they were variants of other already classified disorders The subdivisions of the dyssomnias, intrinsic and extrinsic sleep disorders, divided the major causes of insomnia and excessive sleepiness into those that were induced primarily by factors within the body (intrinsic) and those produced primarily by factors outside of the body (extrinsic) This grouping of the sleep disorders initially had been proposed by Nathaniel Kleitman in his extensive monologue on the sleep disorders that was published in 1939 [6] The medical/psychiatric sleep disorders comprised the medical and psychiatric disorders commonly associated with sleep disturbance The use of the terms medical and psychiatric was not ideal, but was preferred to the ICD-9 use of the terms organic and nonorganic Most medical and psychiatric 188 disorders can be associated with disturbed sleep or impaired alertness, so only those disorders with major features of disturbed sleep or wakefulness, or those commonly considered in the differential diagnosis of the primary sleep disorders, were included in this section The ICSD-I consisted of disorders primarily associated with disturbances of sleep and wakefulness, as well as disorders that intrude into, or occur during, sleep The classification provided a unique code number for each sleep disorder so that disorders could be efficiently tabulated for diagnostic, statistical, and research purposes The primary aim of the text was to provide useful diagnostic information Diagnostic, severity, and duration criteria were presented, as well as an axial system where clinicians could standardize presentation of relevant information regarding a patient’s disorder The axial system, similar to the system used in DSM, was developed to assist in reporting appropriate diagnostic information, either in the clinical summaries or for database purposes The first axis, axis A, contained the primary diagnoses of the ICSD, such as narcolepsy The second axis, axis B, contained the names of the procedures performed, such as polysomnography, or the names of particular abnormalities present on diagnostic testing, such as the number of sleeponset rapid eye movement (REM) periods seen on multiple sleep latency testing The third axis, axis C, contained ICD9-CM medical diagnoses that were not sleep disorders, such as hypertension A brief text revision of the ICSD-I was produced in 1997 and called The International Classification of Sleep Disorders: Revised [36] This revision did not change the overall structure or names of the disorders but mainly involved updating the text ICSD-2 In 2005, the American Academy of Sleep Medicine developed a second edition of the ICSD, called ICSD-2 (Table 23.6) [37] The classification was divided into eight Table 23.6 ICSD-2 outline (2005) Insomnia Sleep-related breathing disorders Hypersomnias of central origin not due to a circadian rhythm sleep disorder, sleep-related breathing disorder or other cause of disturbed nocturnal sleep Circadian rhythm sleep disorders Parasomnias Sleep-related movement disorders Isolated symptoms, apparently normal variants and unresolved issues Other sleep disorders Appendix A: Sleep disorders associated with conditions classifiable elsewhere Appendix B: Other psychiatric and behavioral disorders frequently encountered in the differential diagnosis of sleep disorders ICSD international classification of sleep disorders M Thorpy main sections: (1) insomnia, (2) sleep-related breathing disorders, (3) hypersomnias of central origin not due to a circadian rhythm sleep disorder, sleep-related breathing disorder, or other cause of disturbed nocturnal sleep, (4) circadian rhythm sleep disorders, (5) parasomnias, (6) sleep-related movement disorders, (7) isolated symptoms, apparently normal variants and unresolved issues, and (8) other sleep disorders There were two appendices: Appendix A: Sleep Disorders Associated with Conditions Classifiable Elsewhere; and Appendix B: Other Psychiatric and Behavioral Disorders frequently encountered in the Differential Diagnosis of Sleep Disorders The ICSD-2 contained the majority of the diagnoses included in ICSD-I However, the severity and duration criteria and the axial system of ICSD-I were not included in ICSD-2 In 2011, the process was initiated to revise the ICSD-2 to produce ICSD-3 Major changes are likely, based on a better understanding of the pathophysiology of sleep disorders, although the major group headings are unlikely to change There will be change in the individual disorders some of which will be listed as subtypes The ICSD-3 was published in 2014 [38] References Ebbell B The Papyrus Ebers London: Humphrey Milford; 1937 Kenyon FG Classical texts from Papyri in the British Museum: including the newly discovered poems of Herodas, with autotype facsimiles of MSS London: British Museum; 1981 3 MacNish R The philosophy of sleep Glasgow: WR M’Phun; 1830 Dana CL On morbid drowsiness and somnolence J Nerv Ment Dis 1884; 9:153–76 Pieron H Le Problème Physiologique du Sommeil Paris: Masson; 1913 Kleitman N Sleep and wakefulness Chicago: University of Chicago Press; 1939 Collins J Insomnia: how to combat it New York: Appeleton and Company; 1930 8 Gillespie RD Sleep New York: William Wood and Company; 1930 Westphal C Eigentümliche mit Einschlafen verbundene Anfälle Arch Psychiatr 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1976;119:31–41 20 Roger H Les troubles du sommeil—hypersomnies, insomnies et parasomnies Paris: Masson et Cie; 1932:206p 21 Broughton RJ Sleep disorders: disorders of arousal? 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Partinen () Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland e-mail: markpart@me.com dren slept 10.5–13.5 h, 15-year-olds 9–10 h, and adults between 7 h 25 min and 8 h 23 min These figures not differ significantly from those in the present day Women slept a little longer than men In 1931, Laird published a large study of 509 men of distinction Sleep disturbances increased with age, as they at present At the age of 25 years, about 90 % of men slept well, but by the age of 95 everybody had some sleeping problems On an average, more than 70 % of men of distinction reported some difficulty in going to sleep, and more than 40 % reported awakening during the night [4] The number of epidemiological studies increased in the 1960s In these studies, the average length of sleep varied between and 8 h In Scotland, 2446 subjects aged over 15 were studied Of the older subjects in the age group 65–74 years, 18 % complained of awakening before a.m This decreased to 12 % after the age of 75 Less than 10 % of men aged 15–64 years complained of disturbed sleep In the age group 65–74 years, disturbed sleep was a complaint in 25 % of men In women, the respective percentage was 43 % [5] Increase of Epidemiological Studies During Recent Years In the beginning of 1970, less than 50 publications could be found in PubMed using the following Mesh terms: (“Epidemiology”[Mesh] OR prevalence OR incidence) AND (“Sleep Disorders”[Mesh] OR “Sleep Disorders, Circadian Rhythm”[Mesh] OR “Snoring” OR “Sleep Apnea Syndromes”[Mesh] OR “Sleep Apnea, Obstructive”[Mesh] OR “Sleep Apnea, Central”[Mesh] OR “insomnia” OR “parasomnia”) and limiting the publications to original human studies The number of epidemiological publications started to grow faster at the end of the 1980s In 1990, already 110 studies were published and the figure increased to more than 300 in 2001 Starting from 2008, more than 1000 epidemiological original articles on sleep have been published each year Helsinki Sleep Clinic, VitalMed Research Centre, Helsinki, Finland S Chokroverty, M Billiard (eds.), Sleep Medicine, DOI 10.1007/978-1-4939-2089-1_24, © Springer Science+Business Media, LLC 2015 191 192 Pioneers of Sleep Epidemiology in the USA Excellent articles on individual differences of sleep length were published by Wilse B Webb in Science [6, 7] and also in the classical book Sleep and Dreaming (edited by Ernest Hartmann) in 1970 [8] Webb as well as Hartmann belong to the pioneers of sleep research Webb can be considered a pioneer in sleep epidemiology He has always emphasized the need for using proper methods and criteria Among many other things, he also investigated short and long sleepers “Short sleepers” slept less than 5.5 h per night and “long sleepers” slept more than 9.5 h per night [6, 7] Webb was the first to correlate sleep recording findings with sleep length and stated that short sleepers had reduced amount of stage and rapid eye movement (REM) sleep than average sleepers or long sleepers [6, 7] Webb studied sleep in the elderly as well as effects of shift work, and he always had strong opinions A case in point is his letter to the editor of Sleep “Opinion Polls and Science” where he questioned the opinion polls as scientific evidence (something that I fully agree with) In general, opinion polls have very little to with scientific epidemiology All sleep researchers doing or planning to epidemiological studies should read Webb’s works and verify what he had written about a certain topic Edward Bixler started sleep epidemiological studies in the 1970s and he continues to carry on excellent studies [9, 11–13] He started to work in collaboration with Anthony Kales who is best known for the classic Rechtschaffen and Kales (R&K) scoring system published in 1968 [10] One of the early classic studies on the prevalence of insomnia is the Los Angeles metropolitan study in 1979 [9] It was a well-done population-based survey on 1006 individuals that was designed as a sleep epidemiological study The prevalence of insomnia was 42.5 % Nightmares were reported by 11.2 %, 7.1 % complained of excessive sleepiness, 5.3 % reported sleep talking, and 2.5 % had sleepwalking Insomnia was a major complaint amongst older women and those with lower educational and socioeconomic status [9] Edward Bixler published several landmark studies on the epidemiology of insomnia, parasomnias and sleep apnea Already in the beginning of 1980s, he emphasized that the criteria of clinically significant sleep apnea differ by age His studies also showed a strong correlation between obesity and sleep apnea, and that sleep apnea in postmenopausal women is as common as in men [11–13] Epidemiology of Snoring and Sleep Apnea In 1980, Elio Lugaresi and his collaborators published the first results of the San Marino epidemiological populationbased survey in the journal Sleep [14] It was the first large population-based study on snoring and about the association M Partinen of snoring with cardiovascular disease Also, other sleep disorders were surveyed The Neurological Clinic of Bologna, Italy, is one of the great schools in clinical and clinical– epidemiological sleep research Prof Lugaresi and Giorgio Coccagna were among the first persons together with Henri Gastaut to describe obstructive sleep apnea, which they called hypersomnia with periodic breathing Also, Lugaresi organized the first international symposium “The Rimini Symposium on Hypersomnia and Periodic Breathing” in 1972 Christian Guilleminault introduced the term “sleep apnea” later, in 1975, soon after he had moved from France to work with William Dement at Stanford, USA Shortly after the San Marino studies, the first populationbased epidemiological studies on the prevalence of snoring and sleep apnea were published from USA (Sonia AncoliIsrael, Daniel Kripke, Edward Bixler), Finland (Markku Partinen, Tiina Telakivi), Germany (Jörg Hermann Peter, Thomas Podszus), Israel (Peretz Lavie), Sweden (Thorarinn Gislason), and Denmark (Poul Jennum) Thorarinn Gislason is working presently in his hometown of Reykjavik in Iceland, and he is leading genetic and epidemiological studies in collaborations with Allan Pack at the University of Pennsylvania in Philadelphia, USA Investigators from Iceland are in a unique position for genetic studies because the genetic roots can be traced back to the AD 800s Unfortunately, the Icelandic population is isolated, and replication studies in other populations have been often negative Poul Jennum leads the Danish group of sleep researchers Using the registries that are unique in all Nordic countries, he recently published excellent papers on economical issues of different sleep disorders Prevalence of Sleep Apnea The prevalence of sleep apnea figures varied, depending on the gender and age, between and 6 % which agreed with the results of the Wisconsin population-based study that was published in 1993 by Terry Young and collaborators [15] The first Wisconsin Sleep Cohort study of 602 employed men and women was published in the New England Journal of Medicine Four per cent of men and 2 % of women met the minimal diagnostic criteria of obstructive sleep apnea syndrome These are the most commonly cited prevalence figures of sleep apnea although they are valid only for an employed population As has been shown later by Bixler, sleep apnea is about as common in postmenopausal women as in men of the same age [13] Sleep apnea is very common in elderly people, but the effect on mortality is lower in elderly than in middle-aged people [16, 17] New studies are warranted The occurrence of sleep apnea increases with body weight, and with increasing prevalence of obesity sleep apnea has been increasing more and more This means that the Young figures from 1993 are probably outdated [18] 24 History of Epidemiological Research in Sleep Medicine Sleep and Cardiovascular Disease Markku Partinen and Michel Billiard were students of Pierre Passouant from Montpellier, France Partinen studied medicine in France and he became interested in sleep when he was preparing for a special certificate of neurophysiology with Passouant In 1976, after his return to Finland, he started preparing his doctoral thesis [19] on sleep epidemiology A few years later, he started to collaborate with Markku Koskenvuo and Jaakko Kaprio who had been working at the University of Helsinki with the Finnish twin cohort Questions of snoring and more questions on sleep were added to the surveys A U-type association was found, for the first time between sleep length and occurrence of coronary heart disease [20] This finding has since been replicated in several other studies The association of habitual snoring with arterial hypertension as well as the association between snoring, sleep apnea and myocardial infarction were reported for the first time by Partinen and collaborators in 1983 [21, 22] Since that time, the Finnish group continued reporting on genetic and different environmental effects on sleep [23, 24] and publishing further studies on snoring, sleep apnea, and cardio- and cerebrovascular disease [25–27] These early results have been confirmed later by several other groups Type Diabetes and Sleep Apnea An association between sleep apnea and type diabetes was reported for the first time by Japanese investigators in 1991 [28] Soon, Finnish researchers found that the severity of sleep apnea was related to the degree of insulin resistance [29] The association of sleep apnea with type diabetes was recognized widely including the diabetes research community [30, 31] Mortality and Morbidity in Patients Diagnosed with Sleep Apnea The first convincing studies showing that mortality is increased in untreated sleep apnea were published by two groups in 1988 [32–34] Since then, many other studies have shown an association between sudden death, [35] myocardial infarction, stroke, and sleep apnea The best studies have been prospective studies [36–45] Narcolepsy Narcolepsy studies were initiated in Montpellier, France, and at Stanford University, USA The prevalence of narcolepsy has been studied in many countries The prevalence of nar- 193 colepsy is about 30 per 100,000 people [46–50] The highest figures are from Japan and the lowest are from Israel In France, the early epidemiological studies were conducted mainly in Montpellier Pierre Passouant, teacher of Michel Billiard, organized the First International Symposium on Narcolepsy in La Grande Motte in 1975 together with William Dement and Christian Guilleminault Passouant was one of the pioneers of clinical sleep medicine, including epidemiological understanding, together with William Dement, Christian Guilleminault, Yasuo Hishikawa, and Yutaka Honda Insomnia Insomnia is the most common sleep disorder It is very important and more difficult to treat than sleep apnea Socioeconomically, insomnia poses more economic burden than sleep apnea Several USA groups dominated this field but Europeans have also published many important epidemiological studies on insomnia The Swedish (Jerker Hetta, Gunnar Boman, and many others), British (Kevin Morgan and others), and Norwegians (Reidun Ursin, Björn Bjorvatn, and others) have been active together with Finnish, French and German researchers Sleepiness is an important issue in occupational medicine and in traffic In these areas, the most important studies were conducted by Pierre Philip from France and Torbjörn Åkerstedt from Sweden As for epidemiological studies on narcolepsy, many Europeans have been involved in pioneering studies, including Yves Dauvilliers from Montpellier, Christer Hublin from Finland, and the Swiss colleagues The first international meeting on epidemiology of sleep/ wake disorders was organized in Milano Marittima, Italy, in May 1982 (Fig. 24.1) The proceedings of the excellent meeting were published in the book Sleep/Wake Disorders: Natural History, Epidemiology, and Long-Term Evolution, edited by Christian Guilleminault and Elio Lugaresi History of Other Epidemiological Studies Other European names in the early history of epidemiology of sleeping habits, insomnia, and sleep apnea include Heikki Palomäki (stroke), John Stradling (neck circumference, risk factors, hypertension), Neil Douglas (RCTs, cognition, etc.), Erkki Kronholm (sleep length, insomnia), and Claudio Bassetti (stroke) among many others Talking about history of cardiovascular studies on sleep apnea in Europe, one cannot forget Marburg (Germany) Jörg Hermann Peter was a pioneer in that field, and he organized several important meetings on the topic before he passed away in January 2010 Some of the studies that originated in Marburg are now being 194 M Partinen Fig 24.1 The first international meeting on epidemiology of sleep/wake disorders was organized in Milano Marittima, Italy, in May 1982 Milano Marittima 1982 Bill Dement and Elio Lugaresi are in the middle continued in Gothenburg, Sweden, by Ludger Grote and Jan Hedner One of the pioneers in the area of narcolepsy and hypersomnias had been Prof Bedrich Roth from Prague (Czech Republic) He was born in 1919 and he passed away in 1989 He published his first monograph on narcolepsy in 1957 His blue book on hypersomnias with epidemiological data remains a classic Sonia Nevsimalova and Karel Sonka are continuing his pioneering work Several US groups, in addition to Bixler and Young, have conducted excellent epidemiological studies One important researcher is Maurice Ohayon who is a psychiatrist He became more and more interested in sleep epidemiology after moving from France to Canada The first epidemiological study using the so-called Sleep-EVAL system was published in 1996 [51] Since that time, he has published several crosssectional studies on the occurrence of different sleep disorders There are many other Asian, European, and US colleagues who have conducted epidemiological studies in different areas The list of researchers would be too long, and I have listed only some people who have been important in the history of sleep medicine during its development mainly in the 1980s to the 1990s I apologize to all of those whose names are missing Happily, more and more people are interested in sleep epidemiology With the advent of efficient computers and good registries, studies changed from simple descriptive ones to well-planned case–control, prospective, and multivariate analytic studies of different associations and risk factors References 1 Dukes C Sleep in relation to education J Roy Sanit Inst 1905;26:41–4 Claparède E Théorie biologique du sommeil Arch de Psychologie 1905;4:245–349 Camp C Disturbance of sleep J Michigan Med Soc 1923;22:133– 4 Laird D The sleep habits of 509 men of distinction Am Med 1931;37:271–5 McGhie A, Russell S The subjective assessment of normal sleep patterns J Ment Sci 1962;108:642–54 Webb WB, Agnew HW, Jr Sleep stage characteristics of long and short sleepers Science 1970;168:146–7 Webb WB, Friel J Sleep stage and personality characteristics of “natural” long and short sleepers Science 1971;171:587–8 Webb W Individual differences in sleep length In: Hartmann E, ed Sleep and dreaming Boston: Little & Brown; 1970 p. 44–7 Bixler EO, Kales A, Soldatos CR, Kales JD, Healey S Prevalence of sleep disorders in the Los Angeles metropolitan area Am J Psychiatry 1979;136:1257–62 10 Rechtschaffen A, Kales A A manual of standardized terminology, techniques, and scoring system for sleep stages of human subjects Bethesda: National Institute of Neurological Diseases and Blindness, Neurological Information Network; 1968 11 Bixler EO, Kales A, Soldatos CR, Vela-Bueno A, Jacoby JA, Scarone S Sleep apneic activity in a normal population Res Commun Chem Pathol Pharmacol 1982;36:141–52 12 Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A Effects of age on sleep apnea in men: I Prevalence and severity Am J Respir Crit Care Med 1998;157:144–8 13 Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, et al Prevalence of sleep-disordered breathing in women: effects of gender Am J Respir Crit Care Med 2001;163:608–13 24 History of Epidemiological Research in Sleep Medicine 14 Lugaresi E, Cirignotta F, Coccagna G, Piana C Some epidemiological data on snoring and cardiocirculatory disturbances Sleep 1980;3:221–4 15 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badar S The occurrence of sleep-disordered breathing among middle-aged adults N Engl J Med 1993;328:1230–5 16 Ancoli-Israel S, Klauber MR, Stepnowsky C, Estline E, Chinn A, Fell R Sleep-disordered breathing in African-American elderly Am J Resp Crit Care Med 2000;152:1946–9 17 Bliwise DL, Foley DJ, Vitiello MV, Ansari FP, Ancoli-Israel S, Walsh JK Nocturia and disturbed sleep in the elderly Sleep Med 2008;10:540–8 18 Partinen M, Hublin C Epidemiology of sleep disorders In: Meir Kryger TR, Dement WC, editors Principles and practice of sleep medicine edn St Louis: Elsevier Saunders; 2011 p. 694–715 19 Partinen M Sleeping habits and sleep disorders on Finnish men before, during and after military service Ann Med Milit Fenn 1982;57:1–96 20 Partinen M, Putkonen PT, Kaprio J, Koskenvuo M, Hilakivi I Sleep disorders in relation to coronary heart disease Acta Med Scand 1982;660:69–83 21 Partinen M, Kaprio J, Koskenvuo M, Langinvainio H Snoring and hypertension: a cross-sectional study on 12808 Finns aged 24–65 years Sleep Res 1983;12:273 22 Partinen M, Alihanka J, Lang H, Kaliomaki L Myocardial infarction in relation to sleep apneas Sleep Res 1983;12:272 23 Partinen M, Eskelinen L, Tuomi K Complaints of insomnia in different occupations Scand J Work Environ Health 1984;10:467–9 24 Partinen M, Kaprio J, Koskenvuo M, Putkonen P, Langinvainio H Genetic and environmental determination of human sleep Sleep 1983;6:179–85 25 Partinen M, Palomäki H Snoring and cerebral infarction Lancet 1985;ii:1325–6 26 Koskenvuo M, Kaprio J, Partinen M, Langinvainio H, Sarna S, Heikkilä K Snoring as a risk factor for hypertension and angina pectoris Lancet 1985;1:893–6 27 Koskenvuo M, Kaprio J, Telakivi T, Partinen M, Heikkilä K, Sarna S Snoring as a risk factor for ischaemic heart disease and stroke in men Br Med J 1987;294:16–9 28 Katsumata K, Okada T, Miyao M, Katsumata Y High incidence of sleep apnea syndrome in a male diabetic population Diabetes Res Clin Pract 1991;13:45–51 29 Tiihonen M, Partinen M, Närvänen S The severity of obstructive sleep apnoea is associated with insulin resistance J Sleep Res 1993;2:56–61 30 Tuomilehto H, Peltonen M, Partinen M, Seppa J, Saaristo T, Korpi-Hyovalti E, et al Sleep-disordered breathing is related to an increased risk for type diabetes in middle-aged men, but not in women—the FIN-D2D survey Diabetes Obes Metab 2008;10:468–75 31 Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, et al Obstructive sleep apnea among obese patients with type diabetes Diabetes Care 2009;32:1017–9 32 He J, Kryger M, Zorick F, Conway W, Roth T Mortality and apnea index in obstructive sleep apnea Chest 1988;94:9–14 33 Partinen M, Jamieson A, Guilleminault C Long-term outcome for obstructive sleep apnea syndrome patients Mortality Chest 1988;94:1200–4 195 34 Partinen M, Guilleminault C Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients Chest 1990;97:27–32 35 Seppala T, Partinen M, Penttila A, Aspholm R, Tiainen E, Kaukianen A Sudden death and sleeping history among Finnish men J Intern Med 1991;229:23–8 36 Ancoli-Israel S, Kripke DF, Klauber MR, Fell R, Stepnowsky C, Estline E, et al Morbidity, mortality and sleep-disordered breathing in community dwelling elderly Sleep 1996;19:277–82 37 Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, et al Sleep apnea in 81 ambulatory male patients with stable heart failure Types and their prevalences, consequences, and presentations Circulation 1998;97:2154–9 38 Peppard PE, Young T, Palta M, Skatrud J Prospective study of the association between sleep-disordered breathing and hypertension New Engl J Med 2000;342:1378–84 39 Kaneko Y, Floras JS, Usui K, Plante J, Tkacova R, Kubo T, et al Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea New Engl J Med 2003;348:1233–41 40 Campos-Rodriguez F, Pena-Grinan N, Reyes-Nunez N, De la CruzMoron I, Perez-Ronchel J, De la Vega-Gallardo F, et al Mortality in obstructive sleep apnea-hypopnea patients treated with positive airway pressure Chest 2005;128:624–33 41 Lavie P, Lavie L, Herer P All-cause mortality in males with sleep apnoea syndrome: declining mortality rates with age Eur Respirat J 2005;25:514–20 42 Marin JM, Carrizo SJ, Vicente E, Agusti AG Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study Lancet 2005;365:1046–53 43 Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, et al Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort Sleep 2008;31:1071–8 44 Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O’Connor GT, et al Sleep-disordered breathing and mortality: a prospective cohort study PLoS Med 2009;6:e1000132 45 Hudgel DW, Lamerato LE, Jacobsen GR, Drake CL Assessment of multiple health risks in a single obstructive sleep apnea population J Clin Sleep Med 2012;8:9–18 46 Hublin C, Kaprio J, Partinen M, Koskenvuo M, Heikkilä K, Koskimies S, et al The prevalence of narcolepsy: an epidemiological study of the Finnish Twin Cohort Ann Neurol 1994;35:709–16 47 Wing YK, Li RH, Ho CK, Fong SY, Chow LY, Leung T A validity study of Ullanlinna Narcolepsy Scale in Hong Kong Chinese J Psychosom Res 2000;49:355–61 48 Shin YK, Yoon IY, Han EK, No YM, Hong MC, Yun YD, et al Prevalence of narcolepsy-cataplexy in Korean adolescents Acta Neurol Scand 2008;117:273–8 49 Heier MS, Evsiukova T, Wilson J, Abdelnoor M, Hublin C, Ervik S Prevalence of narcolepsy with cataplexy in Norway Acta Neurol Scand 2009;120:276–80 50 Partinen M Epidemiology of sleep disorders Handb Clin Neurol 2011;98:275–314 51 Ohayon M Epidemiological study on insomnia in the general population Sleep 1996;19:S7–15 The Insomnias: Historical Evolution 25 Suresh Kumar and Sudhansu Chokroverty Introduction To paraphrase David Parkes [1], insomnia can be called by different names just like Wordsworth’s [2] cuckoo (“O Cuckoo! Shall I call thee Bird, or but a wandering Voice?”) because insomnia is thought to be a symptom of many diseases (medical, psychiatric, and others) For an understanding of insomnia, one should begin by studying the inhabitants of the ancient world and the civilization of the Indus (India), Yangtze (China), the Euphrates (Middle East) [1], and Egypt gradually progressing through to modern industrialized and contemporary culture The term insomnia is derived from Latin meaning literally a total lack of sleep But from a practical standpoint it is the relative lack of sleep, non-restorative, or inadequate quality of sleep which is relevant Insomnia is really “hyposomnia” meaning a decrease in duration or depth Henry Cockeram while working on the dictionary of “hard English words” in the early 1620s [3] used the term insomnia synonymous with the word “watching” meaning want of power to sleep Developmental Milestones of Insomnia in the Ancient Time Insomnia Since ancient times sleep and sleep disorders have been mentioned time and again with particular relevance to sleeplessness and various therapies available for it Ancient S. Chokroverty () JFK New Jersey Neuroscience Institute, 65 James Street, Edison, NJ 08818, USA e-mail: schok@att.net S. Kumar Department of Neurology, Sree Balajee Medical College and Hospital, Chrompet, Chennai, India Chennai Sleep Disorders Centre, Chennai, India trea tises on medicine and surgery have existed as early as 400 BC ca and have been the forerunners to the present-day modern texts One such ancient treatise is Charaka Samhita The Advaita Vedanta written in Sanskrit (ca 5000 BC) talks about sleep and wakefulness and the different states were termed avasthas; avasthatraya—the three states, namely waking state ( jagrat), dream sleep ( swapna), and dreamless sleep ( sushupti; see also Chap. 4) The Vedanta further describes that all human beings without any exception experience all these three states on a daily basis [4] The vedas, furthermore, elaborate the presence of a fourth state which is described as a state of true awakening This is defined as a state where there is no interruption by the waking state and is termed “turiyam” or the fourth state Any disruption of the three states would lead to unsatisfactory sleep and awakening The vedas also point out that disruption of the peace of mind by stressors can disrupt the natural process of these three states and lead to sleeplessness The vedas at that time had pointed out the basis of sleep and in fact went on to describe dreamless, and dreaming, motionless sleep which is similar to features of rapid eye movement (REM) sleep They also described the probable psychophysiological concept of insomnia without directly mentioning it as insomnia Ayurvedic medicine existed several thousands of years before Christ Ayurveda considers sleep to be one of three pillars of health Ayurveda, a Sanskrit word means the knowledge for a long life ( Ayu means longevity and Veda means knowledge or science) Ayurvedic medicine is a system of traditional Indian medicine (a form of complementary or alternative medicine) practiced from mid- to second millennium BC to contemporary time During the Buddhist period (ca 300 BC to AD 1000), the knowledge of Ayurvedic medicine spread to far West and East This ancient system of medicine is being taught along with the allopathic medicine in many universities and colleges throughout India now Traditional Chinese medicine (TCM), existing also since many thousands of years before Christ, approaches insomnia in a different way than Western medicine (see also Chap. 5) TCM using the concept of “root and branch” views insom- S Chokroverty, M Billiard (eds.), Sleep Medicine, DOI 10.1007/978-1-4939-2089-1_25, © Springer Science+Business Media, LLC 2015 197 198 nia symptoms as the “branches” and the root of the disease as an imbalance of the fundamental substances (e.g., Chi, Yin, Yang, blood, Jing, Shen) or major organ systems (e.g., heart or liver) According to the TCM concept originating from Shamanism and later Taoism, a wandering spirit or Shen disturbance can manifest most commonly as insomnia symptoms TCM practitioners often combine acupuncture and Chinese herbal medications (e.g., Suan Zao Ren or sour date seed) for treating insomnia A popular herb, Yi-Gen San has been approved for the treatment of insomnia in Japan It is interesting to note that this same herb has been reported to be effective in the treatment of three cases of REM sleep behavior disorder [5] In Western culture, one finds reference to insomnia, probably for the first time in ancient Greeks in the pre-Hippocratic Epidaurian tablets According to the Greco-Roman concept, the people’s lives were controlled by gods and goddesses [6] The goddess of the night (Nyx) had two sons, namely, Hypnos (the god of sleep) and Thanatos (the god of death) The Greek god Hypnos is often symbolized to hold a poppy flower in the hand with a field of poppies in front of his house [3] It is described that in ancient Greece, if a person had issues regarding sleeplessness, he would need to visit the sanatorium of Asclepios (the Greek god of medicine) where he would receive the treatment with soothing music, rest, and meditation This is reminiscent of the cognitive behavioral and relaxation therapies of modern time [7] The present-day therapy like valerian root was already used in the ancient Greek period for the treatment of sleeplessness For example, the ancient Greek physician Dioscorides prescribed valerian root as a sedative Hippocrates (400 BC) mentioned about sleep and sleep-related issues in his writings (Corpus Hippocraticum) [8] In the Egyptian civilization, medical papyri from the Edwin Smith papyrus, the Ebers papyrus, and Kahun papyrus described the use of opium as a treatment for insomnia [9] It is stated that the first-century BC Greek physician Heraclides of Taras, who lived in Alexandria, Egypt, recommended opium as the treatment of choice for insomnia [10] The Indian philosophy describes Nidra Devi as a goddess of sleep and chanting her verses mentioned in the religious book (Chandi path or reading) induces sleep [11] Aristotle offered the first scientific approach in his writings around 350 BC enumerating the most comprehensive theories of sleep Three essays in the collection known as Parva Naturalia (on sleep and waking, on dreams, and on divination through sleep) analyzed the genesis of sleep as well as the concept of dreams [12–14] Quoting Beare’s translation “Likewise it is clear that [of those either asleep or awake] there is no animal which is always awake or always asleep, but that both these affections belong [alternately] to the same animal For if there be an animal not endowed with sense-perception, it is impossible that this animal should ei- S Kumar and S Chokroverty ther sleep or wake; since both these are affections of the activity of the primary faculty of sense-perception.” Aristotle stated that no being can remain always awake or asleep permanently Again quoting Beare’s translation “Finally, if such affection is sleep, and this is a state of powerlessness arising from excess of waking, and excess of waking is in its origin sometimes morbid, sometimes not, so that the powerlessness or dissolution of activity will be so or not; it is inevitable that every creature which wakes must also be capable of sleeping, since it is impossible that it should continue actualizing its powers perpetually.” Aristotle mentioned that excess of waking would make you powerless and tried to explain the intricate balance between sleep and wakefulness Insomnia is mentioned in several places in the Bible (see also Chap. 6) to emphasize the severity, associated loneliness, anxiety, and guilty conscience as well as illnesses causing sleeplessness [15] An example in the Psalms is: “I lie awake, I am like a lonely bird upon a roof” (102:8) The Bible also mentions physical activity as a treatment for insomnia The importance of getting enough sleep at night has also been emphasized in Qur’an and the Islamic literature (see also Chap. 3) [16] Evolution of the Concept of Insomnia from the Nineteenth to Twenty-first Century Frank in 1811 mentioned agrypnia (meaning insomnia) as one of the seven classes of sleep disturbance [17] A search of the literature clearly shows that publications on the topic of insomnia dominated the field of sleep research since 1870 For a description of historical evolution of insomnia and its treatment in the nineteenth and early twentieth centuries, the readers are referred to Chap. 12 by Schulz and Salzarulo Macfarlane [18] in 1890 wrote the definitive text of the nineteenth century defining insomnia as “loss of sleep.” It is interesting to note that Macfarlane considered insomnia as a symptom and not a disease, a view still hotly debated in this century Contemporary sleep medicine defines insomnia as an inability to fall asleep or maintain sleep associated with an impairment of daytime functioning International classification of sleep disorders (ICSD-3) [19] classified insomnia into three categories It can be associated with medical, psychiatric or psychological factors, environmental causes, or ingestion of medication The term secondary insomnia used in the first National Institute of Health (NIH) consensus development conference in 1983 has been replaced by the term comorbid insomnia in the later NIH consensus conference in 2005 [20] as the cause-and-effect relationship has not been determined The Diagnostic and Statistical Manual of the American Psychiatric Association (1994; DSM-IV) classi- 25 The Insomnias: Historical Evolution fied insomnia into primary insomnia and that related to medical or mental disease or to substance abuse or dependency DSM-V (published in 2013) recommends the term “insomnia disorders” replacing “primary insomnia” and “insomnia associated with medical or mental diseases” [21] According to the Center for Disease Control (CDC) of the USA, 70 million Americans suffer from chronic insomnia The lack of a standard definition of insomnia hampered epidemiological studies and limited research on sleep quality Depending on the definition, up to 30 % of the population in the Western countries may experience insomnia symptoms and insomnia may be persistent in 10 % [22] Insomnia diagnosis is based on subjective reports (sleep questionnaires and sleep diaries) rather than objective data derived from polysomnographic (PSG) findings In any case, there appears to be a remarkable discrepancy between PSG and subjective measures Edinger et al published research diagnostic criteria for insomnia [23] Longitudinal studies of the general population in the Western countries suggested high prevalence with varying degrees of persistence with rates varying from 40 to 69 % and the incidence rates of 3.9 to 28.8 % [22] In a longitudinal study (mean follow-up of 5.2 years) of Chinese adults, the researchers in Hong Kong led by Y K Wing found an incidence rate for insomnia symptoms and insomnia syndrome (additional daytime symptoms) of 5.9 %, whereas the persistence rate of insomnia syndrome was 42.7 and 28.2 % for insomnia symptoms [24] Some major advances in insomnia research occurred in the last half of the twentieth and twenty-first century Some examples of these include long-term consequences of chronic insomnia, relationship between insomniac and psychiatric disorders, new understanding about pathophysiology of insomnia, and advances in the treatment First, one must understand that insomnia is a 24-h disease and is not just sleep deprivation Sleep deprivation is endemic in our modern industrialized society Average sleep duration in human has decreased by 1.5–2 h in the course of the last 55 years, which may be partly responsible for adverse metabolic and hormonal effects, and increasing incidence of obesity and type diabetes mellitus in the society [25] Function of sleep, however, remains a mystery but we have enough evidence to show that sleep plays an important role in homeostatic mechanism with restitution of sleep, thermoregulation, immune control, and tissue repair, as well as memory consolidation [26] Even one night of sleep deprivation impairs hippocampal function resulting in inadequate memory processing [27] Jenkins and Dallenbach’s experiment in 1924 [28] proved that memory retention was better after a night of sleep and this was later supported by behavioral and functional magnetic resonance imaging (fMRI) studies by Stickgold and Walker [29] An early observation by Kripke et al [30] in 1979 of increased risk of death from coronary arterial disease, cancer, and stroke in those who sleep less than 4 h 199 (also those who sleep more than 10 h) was later confirmed [31], but remains controversial without resolving cause and effect and because of the confounding factor of medication ingestion However, short-term consequences, such as excessive daytime sleepiness, mood disorder, irritability, impaired work efficiency and absenteeism, accidents at work and home, and falls in the elderly, and long-term (remains debatable) consequences, such as increased mortality and morbidity (e.g., obesity, type diabetes mellitus, hypertension, and other adverse cardiovascular consequences, psychiatric disorders, and memory impairment, have been reported in patients with chronic insomnia [32] Obstructive sleep apnea (OSA) is an additional comorbidity and up to 50 % of OSA patients may suffer from moderate to severe insomnia [33] There is a clear bidirectional relationship between insomnia and depression [34] In 1969, Winokur et al [35] reported that 100 % of their sample of 1257 patients with depression had comorbid insomnia and these observations have been subsequently confirmed in many reports [34] Significant advances have been made in the last decade of the twentieth and current century in our understanding of the pathophysiology of chronic insomnia There are many models and theories proposed Various models focused on primary insomnia rather than comorbid insomnias as the latter represent heterogeneous conditions Richardson [36] proposed four physiological models: (1) disruption of the sleep homeostat; (2) disruption of the circadian clock; (3) disruption of intrinsic sleep–wake state mechanisms; and (4) disruption (hyperactivity) of extrinsic “override” systems (e.g., stress response mechanisms) A detailed discussion of these models is beyond the scope of this chapter but available data favor the involvement of dysfunctional extrinsic stress response systems Physiological hyperarousal remains the contemporary theory inspired by studies undertaken earlier by Monroe [37], Kales [38], Adam [39], and coinvestigators, Bonnet and Arand [40] and continuing with Perlis [41], Vgontzas et al [42], and other investigators [36] Perlis [41, 43] and coinvestigators have provided a comprehensive review of the hyperarousal theory The sustained hyperarousal throughout 24 h explains the persistence of chronic primary insomnia The hyperarousal theory is based on the evidence of physiologic arousal with increased autonomic activity (e.g., elevated heart rate and body temperature), sympathetic arousal (measured by heart rate variability), activation of neuroendocrine (e.g., hypothalamo–pituitary–adrenal [HPA] and neuroimmunological axes), and heightened cortical arousal (e.g., increased beta and gamma frequency electroencephalography (EEG) activity at sleep onset and during non-REM (NREM) sleep with the higher high-to-low frequency ratio in the fast Fourier transformation (FFT) of the EEG signals, and altered brain metabolism as evidenced by the positron emission tomographic (PET) scan findings of heightened neural activation in brain areas subserving 200 arousal and emotion during sleep in insomnias) [41, 43–46] The increased production of cortisol and interleukin-6 in patients with chronic insomnia support the activation of the HPA and neuroimmunological axes [42] The finding of a reduction in hippocampal volume [47] in insomnias and the experimental observations of impaired neurogenesis in the hippocampus following sleep loss in rats [48] support cognitive deficits and impaired memory consolidation in patients with chronic insomnia Finally, using a sophisticated immunohistochemical method (Fos activation indicating neuronal activation), Cano et al [49] produced a stress-induced insomnia model in rats to show simultaneous activation of both sleep-promoting and arousal-related brain regions similar to the observations in human insomniacs of simultaneous fatigue throughout the day and an inability to “de-arouse” on attempting to sleep Evolution of Insomnia Treatment from the Ancient Time to Twenty-First Century Natural remedies to promote sleep and as a treatment for sleeplessness were popular in the ancient time with the use of chamomile (medicinal herb in the form of tea) St John’s Wort and mandragora (mandrake tree) as sleeping aid have a history of use over 2400 years for various disorders including sleeplessness Ayurvedic medicine, the oldest comprehensive medicinal system of India, describes the use of yoga and “ashwagandha” to cure insomnia [49a] Ashwagandha, also known as Withania somnifera in Latin or “Indian winter cherry” or “Indian ginseng,” contains steroidal lactones, anaferine, and heterogonous alkaloids, which reduce the production of cortisol Ashwagandha promotes a calm state of mind by its restorative action in the nervous system, which counteracts tension and high blood pressure This brings the body to a state of equilibrium, making the body to relax during stress and fatigue thus restoring sleep to insomnia patient Likewise, “brahmi,” also known as Bacopa Monnieri in Latin, was also used in the ancient times to promote sleep The current concept is that “brahmi” increases the levels of serotonin and bacosides Insomnia treatment includes pharmacological therapy using hypnotic medications and non-pharmacologic treatment using lifestyle and behavior modifications In the nineteenth and twentieth centuries, hypnotic medications had been used frequently for insomnia (see also Chap. 12) As mentioned earlier, opium was first used as a hypnotic in Egypt (ca 1000 BC) From the ancient time until the nineteenth century, alcohol, opium, or a dilute solution of the active ingredient in the opium poppy seed, morphine, was the ingredient for sleeping medications Morphine may have S Kumar and S Chokroverty been named after Morpheus (the god of dream and the son of Greek god of sleep Hypnos and the equivalent Italian god of sleep Somnus) In the nineteenth century, bromides, chloral hydrate, and paraldehyde were used as hypnotics, which were later superseded by barbiturates in the beginning of the twentieth century Benzodiazepines replaced barbiturates in the second half of the twentieth century followed later in the past decade of the twentieth century by imidazopyridines, the non-benzodiazepine GABAA receptor agonists (popularly known as Z drugs: zolpidem, zopiclone, including eszopiclone, and zaleplon) Over-the-counter (OTC) medications (all containing antihistamines) and alcohol are frequently used by the public presently as nonprescription aids for insomnia Other prescription drugs currently used as hypnotics include antidepressants (Trazodone and Mellaril (Elavil) in particular); however, at the 2005 NIH state-of-the science consensus conference [20], these medications were discouraged to be used as hypnotics The role of non-pharmacological treatment for insomnia was clearly evident even in the nineteenth century in the form of sleep hygiene, and the other measures (e.g., behavioral therapy) were mentioned in the twentieth century (see also Chap. 12) As early as 1880s, hydrotherapy (e.g., baths, showers, wraps, warm douching) was used for sleeplessness [50, 51] Spielman’s 3P (predisposing, precipitating, and perpetuating factors) model of insomnia [52] paved the way for modern cognitive behavioral therapy for insomnia (CBT-I; see also Chaps. 58 and 60) CBT-I basically consists of five components [53–58]: (1) sleep hygiene measures [56]; (2) stimulus control therapy (SCT) of Bootzin [57]; (3) sleep restriction therapy (SRT) of Spielman [58]; (4) progressive muscle relaxation (PMR); and (5) cognitive therapy (CT) Later a web-based (internet-based intervention) CBT treatment was introduced in a 2012 publication [59] The two main goals of the treatment for chronic insomnia advocated by the American Academy of Sleep Medicine (AASM) are to improve the quality of sleep and to improve the next-day impairment of function [60] AASM guidelines recommend CBT for chronic primary as well as comorbid insomnias Non-pharmacological intervention is shown to be superior to hypnotic treatment alone in a head-to-head comparison [61] and CBT is considered the treatment of choice for chronic insomnia [62] Combined behavioral and pharmacological treatment may be needed in some patients but many unresolved issues remain in this approach [63, 64] Comorbid insomnia including comorbid depression and insomnia requires a treatment for both the primary condition and insomnia itself It is 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Sleep Med 2006;7(suppl 1): S15–19 64 Reimann D, Perlis MI The treatment of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies Sleep Med Rev 2009;13:205–14 ... Macbeth, A Midsummer Night’s Dream, and Richard III, Tolstoy’s War and Peace and Anna Karenina, and Dostoevsky’s Crime and Punishment and The Brothers Karamazou; and sleep paralysis and nightmare... Models���������������������������������������������������������������������������������������� 511 Mitsuyuki Nakao, Akihiro Karashima and Norihiro Katayama Part XII Evolution of Treatment and Investigative Approaches in Sleep Medicine 58 A History of Nonpharmacological Treatments... northern Africa including Egypt as well as Syria, Palestine, Transjordan, Central Asia, and parts of western India Later, it was spread by Muslim merchants to the Far East: Malaysia and Indonesia [2]