Mapping the Darkness by Kenneth Miller

Author:Kenneth Miller [MILLER, KENNETH]
Language: eng
Format: epub
Publisher: Hachette Books
Published: 2023-10-03T00:00:00+00:00

1. disorders of initiating and maintaining sleep (insomnias)

2. disorders of excessive somnolence

3. disorders of the sleep-wake cycle

4. dysfunctions associated with sleep, sleep stages, or partial arousals (parasomnias)62

Unlike manuals for, say, oncology or cardiology, the Diagnostic Classification of Sleep and Arousal Disorders was based mostly on symptoms, not signs; as in psychiatry (where most of the era’s sleep clinicians got their start), ailments were identified by how they made patients feel and behave rather than on evidence such as cancerous cells or an arterial blockage. Also as in psychiatry, only a few of these conditions could be adequately controlled by medication or surgery. For most sleep disorders, alternatives ranging from talk therapy to changes in personal habits or societal arrangements were potentially more effective.63

In response to the IOM report, policy-makers began to pay attention to sleep for the first time. In December 1979, US surgeon general Julius Richmond launched Project Sleep, designed to promote the reforms the institute had called for.64 The initiative would be “a major educational and research effort aimed at increasing the level of knowledge by physicians, their patients, and the public about the nature of insomnia and sleep disorders and their treatment,” Richmond declared.65 Project Sleep generated enormous excitement in the sleep science community—and enormous disappointment when funding was eliminated by the incoming administration of President Ronald Reagan just over a year later.66 Nonetheless, the field was on the verge of another set of transformations.

One harbinger was a two-issue package of articles in Sleep, published in the spring and summer of 1980. Titled “REM Sleep: A Workshop on Its Temporal Distribution,” the series heralded sleep science’s belated but passionate embrace of chronobiology, two decades after Cold Spring Harbor. It included six papers with Czeisler as lead or coauthor (with Weitzman, neurophysiologist Martin Moore-Ede, and others), presenting the REM-related findings from his isolation-lab studies. It also featured Carskadon’s chronobiological reanalysis of her ninety-minute-day study, and several other articles on related topics.67 Czeisler and his East Coast colleagues published a landmark paper in Science that year as well, reporting his discovery of the relationship between sleep length and body temperature rhythms.68

Another sign of things to come was a second article by Carskadon (with Stanford coauthors Dement, Thomas Anders, adolescent medicine pioneer Iris Litt, pediatrics fellow Paula Duke, and undergraduate lab assistant Kim Harvey) in the summer 1980 issue of Sleep. Reporting her Sleep Camp findings on daytime drowsiness in adolescents, it was the first scientific paper to hint at a sleep crisis among teenagers.69

These publications pointed toward new approaches to sleep medicine, not only in the therapeutic realm, but also in the arenas of public health and workplace policy. The field would soon be in a position to affect millions of lives and to spawn a multibillion-dollar industry. The study that nudged it into place, however, came from an entirely unexpected direction.

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