John Peever.

Interview with John Peever, who studies the brain mechanisms that control REM sleep and how their dysfunction underlies sleep disorders at the University of Toronto.

Considerations about the Neuropsychiatric Conditions of Quixote of La Mancha. / Consideraciones sobre las condiciones neuropsiquiátricas del Quijote de la Mancha.

Don Quixote of La Mancha, the picturesque character created by Miguel de Cervantes Saavedra in his immortal book The Ingenious Nobleman Sir Quixote of La Mancha, presents several neuropsychiatric conditions, including tremor, sleep disturbances, neuropsychiatric symptoms, syncope, perception disorders and traumatic brain injury. Throughout the masterpiece, there are episodes where the aforementioned disorders are evident. This paper makes a list of them and analyses them in the light of the current knowledge of those conditions.

Cancer, sleep problems, and mind-body medicine use: Results of the 2017 National Health Interview Survey.

BACKGROUND: Sleep problems affect physical and emotional well-being as well as immune system function. Evidence has demonstrated an improvement in sleep problems in patients with cancer through the use of mind-body medicine (MBM). In the current study, the authors sought to elucidate the prevalence of sleep problems and the use of MBM in adult cancer survivors. METHODS: The authors analyzed data from the 2017 US National Health Interview Survey (NHIS) to estimate the prevalence of sleep problems and use of MBM in adult cancer survivors using means, standard deviations, weighted frequencies, and distributions. Backward stepwise multiple logistic regression analyses were used to identify independent predictors of MBM use within the past 12 months: age, sex, ethnicity, region, educational level, employment, and time since cancer diagnosis. RESULTS: A weighted total of 13,750,028 cancer survivors (59.2%) reported sleep problems. For the most part, survivors with sleep problems were aged ≥40 years, female, and non-Hispanic white. More survivors with (weighted N = 3,794,493; 27.6%) compared with without (weighted N = 1,695,435; 17.9%) sleep problems used MBM. Among cancer survivors with sleep problems, the most commonly used mind-body practice was spiritual meditation (weighted N = 1,972,578; 14.3%), followed by yoga (weighted N = 1,695,553; 17.9%). The use of MBM was independently predicted by being female, living in the western United States, having a higher educational level, and being employed. CONCLUSIONS: The high prevalence of sleep problems in cancer survivors is a major health issue that needs to be addressed. A considerable number of cancer survivors with sleep problems use MBM. This finding warrants the investigation of MBM concepts as treatment options for cancer survivors experiencing sleep problems.

Sleep and sleep disorders in Franz Kafka's narrative works.

OBJECTIVE: As Franz Kafka, one of the most important writers of the 20th century, suffered from severe chronic insomnia disorder and inadequate sleep hygiene that impaired his quality of life, we speculated that sleep disorders would be found in his narrative works. METHODS: We read Kafka's complete literary works looking for references to sleep and sleep disorders, excluding insomnia. RESULTS: In Kafka's works, sleeping well and for a long time was used as an allegory of having a pleasant life. We found that some of his characters were disturbed by excessive daytime sleepiness and sleep attacks, circadian rhythm sleep-wake disorders, sleep-related hallucinations, sleep symptoms in the context of heart failure and abnormal sleep behaviors (eg, sleep-talking, sleep-crying, sleep-laughing and dream-enacting motor manifestations). Kafka also recalled a dream where bruxism occurred. CONCLUSION: Kafka's narrative works contain characters suffering from a wide variety of sleep disorders which in some cases represent autobiographical elements but not in others indicating that he was an astute observer of people, sleep and its disorders. The inclusion of characters suffering from sleep disorders was used by Kafka as a literary resource to enrich his texts.

What sleep research can learn from history.

This article, in noting the recent interest of historians in sleep, assesses both the difficulties and the advantages of studying human sleep in the past. The history of sleep affords important new perspectives not only on everyday life in earlier centuries but also on the underlying origins of contemporary sleep disorders, including middle-of-the-night insomnia.

When sleep-related hypermotor epilepsy (SHE) met Charles Darwin and Francis Galton.

Sleep-related hypermotor epilepsy (SHE) is characterized by short-lasting seizures patterned by repetitive and stereotyped motor events in the same person. In autosomal dominant SHE, genetic factors play a well-known key role. In The Expression of Emotions in Man and Animals, Charles Darwin quotes a plausible example of SHE illustrated by his cousin Sir Francis Galton: "the gentleman…lay fast asleep on his back in bed, raising his right arm slowly in front of his face, up to his forehead, and then dropping it with a jerk, so that the wrist fell heavily on the bridge of his nose. The trick did not occur every night, but occasionally, and was independent of any ascertained cause. Sometimes it was repeated incessantly for an hour or more." Similar manifestations during sleep occurred also in the patient's son and granddaughter, suggesting an autosomal inheritance without sex relationship. Differential diagnosis with REM behavior disorder and other parasomnias is discussed. To our knowledge, this could be the first description of a stereotyped SHE pattern with genetic transmission.

From nocturnal frontal lobe epilepsy to Sleep-Related Hypermotor Epilepsy: A 35-year diagnostic challenge.

Nocturnal frontal lobe epilepsy (NFLE) is a focal epilepsy with seizures arising mainly during sleep and characterized by complex, often bizarre, motor behavior or sustained dystonic posturing. First described in 1981, it was initially considered a motor disorder of sleep and was named nocturnal paroxysmal dystonia (NPD). The unusual seizure semiology, onset during sleep, and often uninformative scalp EEG and brain MRI make it difficult to distinguish NPD attacks from other non-epileptic nocturnal paroxysmal events, namely parasomnias. The long-debated epileptic origin of the condition was finally demonstrated in 1990 and the term NFLE introduced. Even though many aspects of parasomnias and NFLE have been clarified in the last two decades, the differential diagnosis remains a challenge for clinicians. To address controversial issues and define the diagnostic criteria for NFLE, a Consensus Conference was held in Bologna, Italy in 2014. Major points of agreement emerged on: (i) the relationship of the seizures with sleep and not with the circadian pattern of seizure occurrence; (ii) the possible extrafrontal origin of hypermotor seizures, without substantial differences in seizure semiology. In the wake of the Consensus, the syndrome was renamed Sleep-Related Hypermotor Epilepsy (SHE).

Emil Kraepelin's concepts of the phenomenology and physiology of sleep: The first systematic description of chronotypes.

Emil Kraepelin is considered one of the most influential psychiatrists ever. His research on sleep, however, has received little attention to date. Therefore, Kraepelin's published work was reviewed, statements on the topic "sleep" identified, historically contextualized and compared with current knowledge. His assumptions on the "physiology of sleep" are rather speculative and not substantiated by own research. The opposite is true for his findings on the "phenomenology of sleep". For example, his results on sleep depth and sleep stages are not only in overall good agreement with current concepts, but also based on sleep studies. Of special relevance are his findings on chronotypes: Based on empirical clinical studies, neuropsychological experiments and sleep studies, Kraepelin systematically described a morning and evening disposition and intermediate types on the basis of the maximum physical capacity, cognitive ability and alertness/sleepiness during the day as well as sleeping habits. In fact, this concept is basically still valid and these aspects are being captured in morningness-eveningness scales. Our findings challenge the common notion that Nathaniel Kleitman was the first to systematically describe the morningness-eveningness dimension. Overall, we deem Kraepelin's contributions to sleep research, compiled here for the first time, well worth being acknowledged by modern sleep research.

[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.

Sante De Sanctis (1862-1935), a forerunner of the 20th century research on sleep and dreaming.

This article aims to reconstruct the elements of continuity and/or discontinuity in Sante De Sanctis' (1862-1935) contributions in the scientific understanding of sleep and dreaming as compared to the scientific research of his time. An Italian psychologist and psychiatrist, De Sanctis, in his work conducted between the 19th and 20th centuries, has framed the study of dreams using multi-methodology. In addition, De Sanctis experimentally established the correspondence between the deep and desynchronization phases of sleep with respect to dreaming. In this context, De Sanctis' subjects described the periodicity of sleep and consciousness, influencing the explanations of the themes that modern sleep research has, after decades, systematically studied. We demonstrate that De Sanctis' work has been underestimated, and in our opinion, deserves to be reconsidered as a source of the psychophysiological explanation of dreams and sleep. Finally, we present a graphical representation of De Sanctis' psycho- and neurophysiological model of dreaming.

Professor Elio Lugaresi's contributions to neurology and sleep disorders.

The authors present a brief historical review of the most important contributions by Professor Elio Lugaresi, of the University of Bologna, Italy, to neurology and sleep disorders.

Professor Elio Lugaresi's contributions to neurology and sleep disorders / As contribuicoes do Professor Elio Lugaresi para a neurologia e os disturbios do sono

The authors present a brief historical review of the most important contributions by Professor Elio Lugaresi, of the University of Bologna, Italy, to neurology and sleep disorders.

Os autores apresentam uma breve revisão histórica sobre as mais importantes contribuições do Professor Elio Lugaresi, da Universidade de Bolonha, Itália, para a Neurologia e para os distúrbios do sono.

Sleep and fatigue countermeasures for the neurology resident and physician.

PURPOSE OF REVIEW: Fragmented sleep, prolonged work hours, misalignment of sleep-wake cycles, and an expectation to make medical decisions when alertness levels are reduced are pervasive in neurology residency training. Sleep loss in residency training can lead to cognitive and psychosocial impairment and accidents, compromise patient care, and reduce the trainee's quality of life. Neurology residents experience levels of hypersomnolence similar to residents in surgical specialties and have comparable subjective levels of sleepiness as persons with pathologic sleep disorders such as narcolepsy and obstructive sleep apnea. Over the past 2 decades, work-hour limitations were established to alleviate fatigue and sleepiness. However, the implementation of work-hour limitations alone does not guarantee alleviation of fatigue and may be insufficient without additional key measures to prevent, counteract, and control sleepiness when it strikes. This article provides effective strategies to combat sleepiness, such as modification of the on-call structure (night float), power naps, and caffeine, in neurologists in training and those who are at risk for excessive sleepiness. RECENT FINDINGS: Despite two specific work-hour restrictions set by the Accreditation Council for Graduate Medical Education, the most recent in July 2011, little data exist about the efficacy of work-hour restrictions alone in improving fatigue and sleepiness. Curtailed work hours, while appearing attractive on the surface, have important financial, educational, and patient care imperfections and fail to address the core issue--sleepiness. SUMMARY: Historically, sleepiness and fatigue place both residents and patients at risk. Excessive sleepiness in residency training occurs because of sleep deprivation and a spectrum of other factors, such as mood disorders or even the anxiety of anticipating being woken up. An effective model to counteract sleep deprivation and its consequences is a multiplayer approach that uniquely targets and addresses the needs of all the stakeholders. A sleep medicine perspective is proposed along with other interventions to prevent adverse consequences.

There and back again: a current history of sleep medicine.

Sleep science has been a vigorously evolving field over the past 60 years, and the practice of sleep medicine has become increasingly complex with a growing number of tests and treatments. This article briefly traces the history of the field of sleep science over the past three millennia. The foundations of sleep medicine can be traced back to ancient civilizations around the globe. Many philosophers, scientists, and researchers have espoused theories about the causes of sleep throughout the centuries, theories that have become more intricate as our understanding of medicine and neurobiology has continued to advance.