A Succinct History of Sleep Medicine.

Although sleep and sleep disorders have been studied for centuries, it was the development of sophisticated tools to monitor eye movements, brain waves, and muscle tone in the mid-20th century that led to modern sleep research. These tools allowed neuroscientists to distinguish between different "states" or "phases" of sleep, and to relate these findings to sleep disorders. This review chronicles the groundbreaking work of the pioneers in this field, and the impact their findings have had on patients today.

[Sleep Medicine: 1965 to 2015]. / La médecine du sommeil : 1965-2015.

The Département de psychiatrie de l'Université de Montréal houses one of the first sleep centers founded 40 years ago. This center contributed to virtually every aspect of sleep medicine. It grew considerably over time to become one of the largest sleep centers worldwide. It is now called the Center for Advanced Research in Sleep Medicine (CARSM). Fourteen researchers and more than 30 research PhDs and postdoctoral fellows are working together in a 1,500 square-meter facility that includes separate units for fundamental and clinical studies and for the sleep disorders clinic. It has 10 polysomnographic recording rooms, 3 isolated units devoted to chronobiological studies, a high resolution SPECT imaging laboratory specifically devoted to sleep research, a high-density EEG unit and a psychophysiological laboratory to study the interaction between pain and sleep. This article relates the history of the CARSM and also presents a personal sleep odyssey.The CARSM has been very active in the description of clinical features and definitions of the phenotype of most sleep disorders. It contributed specifically to the development of diagnostic tools in narcolepsy (the multiple sleep latency test in different age groups), in nocturnal epilepsy (development of a method to localize the primary focus using in-depth electrodes recording during rapid eye movement sleep), in sleep bruxism (a method for scoring masticatory muscle activity during sleep and definition of cut-off values), in the restless legs syndrome (RLS: the suggested immobilisation test), in sleepwalking (sleep deprivation and experimental awakenings) and REM sleep behaviour disorder (RBD: development of the first polygraphic method to diagnose RBD).The CARSM also contributed to the knowledge on the epidemiology of sleep disorders, conducting the first population-based prevalence study of RLS and of sleep bruxism. Researchers at the CARMS also looked at the impact of sleep disorders like narcolepsy, RLS, sleep apnea and the parasomnias on daytime cognitive functions and cardiovascular health. The CARSM collaborates with researchers throughout the world to elucidate the genetic bases of several disorders, especially narcolepsy, RLS, RBD and parasomnias in children and adults, through large well-defined cohorts of patients and normal subjects.Finally, the CARSM has made original contributions to the development of new treatments of sleep disorders, especially the dopaminergic treatments of RLS (first with levodopa and then with pramipexole). Current research also involves the identification of prodromal markers of Parkinson disease and dementia in patients with RBD as to build a ready-to trial cohort to test the efficacy of neuroprotective agents.In summary, the CARSM is a center dedicated to basic and clinical research on sleep and circadian rhythms. It is located at the Hôpital du Sacré-Coeur de Montréal but involves several other researchers at the Université de Montréal and at other universities in Canada and in the world.

[Treatment of sleep disorders in children with a psychiatric diagnosis]. / Le développement d'une approche clinique pour les troubles du sommeil en pédopsychiatrie.

OBJECTIVES: Health sciences suffer from insomnia: experts too often concentrate their efforts on the wake state. Fortunately enough, some of them have taken the road towards the "Dark Third of Life": sleep. This article gives an historical account of the development of the first Canadian sleep disorders laboratory and clinic specifically and selectively designed for children and adolescents with a psychiatric diagnosis. It then stresses the importance of sleep in children bearing a psychiatric diagnosis and summarizes therapeutic strategies. METHODS: Data-on-file and selective review of literature. RESULTS: An innovative scheme matching sleep psychologists and psychiatrists with expertise in neurodevelopmental disorders led to the creation of a sleep research laboratory on mental health disorders. The initial research projects on the sleep and dreams of patients with schizophrenia and persons with autism are summarized. The Sleep Disorders Clinic for Children and Adolescents was then created at the Hôpital Rivière-des-Prairies, leading to much needed activities focused on youth. Indeed, sleep disorders show a high prevalence in children with a psychiatric diagnosis and the literature shows that these children have an increased sensitivity for diurnal effects of poor sleep. The main sleep-relevant issues at stake are reviewed, including the high frequency of sleep disorders in pedopsychiatric patients. Clinical challenges are described and the operating mode of the Sleep Disorders Clinic is illustrated. CONCLUSION: Sleep disorders and their effects on daytime functioning need to be assessed in children with a psychiatric diagnosis in order to generate a full clinical picture. Appropriate tools and know-how are readily available in order to achieve this goal.

[The contributions by Emil Kraepelin to the knowledge on sleep disorders and their treatment]. / Die Beiträge von Emil Kraepelin zum Wissen über Schlafstörungen und deren Behandlung.

While Emil Kraepelin's comprehensive psychiatric oeuvre has attracted researchers' attention, his studies on sleep disorders and their treatment as well as on the interconnections between sleep and mental disorders so far seem to have been neglected.This article identifies and analyzes Kraepelin's sporadic contributions on the pathology of sleep, the comorbidities and treatment made between 1883 and 1924 in textbooks and isolated papers as well as in a presentation that was also published and compares them with current opinions in sleep research.Kraepelin never published a dedicated work on sleep, apart from a summary of the different narcotics; however, his occasional statements reveal astonishing insights and in particular his clear etiologically oriented classification of sleep disorders is captivating. Similar to the current classification, Kraepelin conceptualized sleep disorders as symptoms or rather a complex of symptoms and also identified associated diseases which once again are very near to current opinion. Apart from this his recommendations on sleep hygiene and, in a second step, pharmacological treatment of pathological sleep patterns are still clinically relevant. As early as the end of the nineteenth century Kraepelin laid down an algorithm of treatment which is very similar to the current clinical guidelines. At Kraepelin's time it seemed impossible to reach an agreement on classification and treatment issues of sleep disturbances and even though there has been an ongoing discussion until the present day, an agreement at least about guidelines could be reached. Against this background Kraepelin's contributions can still be regarded as a proposal for best practice.