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Sleep disorders are common age-old problems that can lead to distress and discomfort, impaired daytime functioning, and serious complications. In ancient Greece, Democritus believed that physical illness was the cause of daytime sleepiness and that poor nutrition was the main cause of insomnia. Effects of sleep on epilepsy and asthma were recognized in the Middle Ages, and Thomas Willis, a British physician of the 17th century, described nightmares and restless legs. For most of recorded history, however, sleep problems were considered a result of medical or psychiatric illnesses rather than primary disorders. Sleep was viewed as a passive process, akin to death, and the idea that disordered sleep physiology could lead to specific syndromes was unknown.

With the discovery of rapid eye movement (REM) sleep in 1953, the concept of sleep as a passive shutting down of cortical activity began to change to a view of sleep as an active process initiated by specific events of the nervous system and with two distinct states: REM and non-REM (NREM). The discovery of the association of narcolepsy with sleep-onset REM periods, as opposed to the usual onset of sleep in the NREM state, led to the idea that narcolepsy was a primary disorder of the sleep process and to the corollary that clinical syndromes could be caused by such disruption of sleep processes.

Forty years ago, the only sleep disorder of interest to most neurologists was narcolepsy; all other sleep problems generally were considered manifestations of psychiatric problems. The discoveries of sleep apnea and periodic leg movements, the use of sleep laboratories to study sleep patterns, the discovery of effective treatments for sleep apnea, and the recognition that untreated sleep apnea is associated with increased cardiovascular morbidity and mortality have dramatically changed the approach to sleep disorders. At present, most sleep medicine specialists have primary training in neurology or pulmonary medicine and the practicing neurologist is often expected by colleagues to be familiar with the major sleep disorders. '1

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Sleeping Sound

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