By Rafael Pelayo, M.D.
Perhaps nowhere else does modern neuroscience and psychiatry merge as naturally as in a discussion of sleep disorders. Sleep and dreams are at the core of the mystery (and wonderment) of the relationship between the brain and the mind. Seeking an understanding of sleep has been influential in the development of our culture. As we trace its history, we can also look forward to the advances in the field of sleep medicine that are yet to come.
In prehistoric societies, attempts to understand the imagery of nighttime dreams and nightmares might have given rise to concepts of the spiritual world and religion. In medieval times, the phenomena of sleep paralysis, night terrors, and sleepwalking may have been interpreted as supernatural events.
Three hundred years ago the recurring nighttime afflictions of restless leg syndrome were thought to be a curse until Dr. Thomas Willis (famed for recognizing the blood supply to the brain, now called the Circle of Willis) accurately described it as a neurological disease. In the late 19th century sleep was viewed as a passive state which occurred in the absence of brain stimulation. Thomas Edison even thought that the invention of the light bulb would allow us to avoid sleeping.
The interest of a young neurologist named Sigmund Freud in sleep and dreams opened a new chapter in psychiatry. Years later, a medical student named William Dement was interested in finding a neurological basis to understand Freud's dream theories. In 1952, Dement helped discover the relationship between rapid eye movements in sleep as measured by an electroencephalogram (EEG) and dream recall. Infants and small children were even an early part of Dement's research into rapid eye movement (REM) sleep.
Dement later joined the department of Psychiatry at Stanford University and studied the relationship of sleep and dreams to mental illness. In 1972, along with Christian Guilleminault, he established the first clinic devoted exclusively to the treatment of sleep disorders. Not surprisingly, children were among the first patients seen at the new clinic. In time, this would become the world-renowned Stanford Center for Sleep Sciences and Medicine.
This landmark sleep clinic served as a worldwide model for the comprehensive multidisciplinary care of sleep problems. The spread of clinical sleep medicine knowledge eventually led to the American Council of Graduate Medical Education to recognize it as a unique medical specialty. To this day, Stanford supports the largest ACGME training program in sleep medicine in the country. Each year, eight fellows previously trained in pulmonology, neurology, psychiatry, otorhinolaryngology, pediatrics, and other specialties complete their medical training with a one-year sleep medicine fellowship at Stanford.
In 2009, the historic clinic previously situated on Quarry Road near Stanford's main campus was relocated to a state-of-the-art 14 bedroom facility at the Stanford outpatient campus in Redwood City. Thousands of patients are seen every year for diagnosis and management of sleep disorders, of which approximately 25 percent are children. This speaks to the future of sleep medicine: recognizing these conditions in childhood so that interventions can change development, affecting everything from growth to behavior. It is a significant need and one that deserves wider attention on a national and international basis.
Decades ago the synergy of neuroscience and psychiatry was essential in establishing this new field. The study of normal sleep and sleep disorders in children is an especially integral part of the development of the future of modern sleep medicine.
Rafael Pelayo, M.D., is a pediatric neurology-trained sleep medicine specialist and clinical professor at the Stanford Center for Sleep Sciences and Medicine. This Center is the birthplace of sleep medicine and includes research, clinical, and educational programs that have advanced the field and improved patient care for decades. To learn more, visit us at: http://sleep.stanford.edu/.