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"Should conceited fools, however, censure me, then let love for my profession steel me against them, so that I remain steadfast without regard for age, for reputation, or for honor" Maimonides prayer.
(Maimonides -1135 - 1204- was a physician and philosopher at the court of Saladin -Kurd dynasty which reigned over Egypt and Syria-)

... Beyond the somnologic problematics themselves (insomnia, sleepiness) our experience leads us to formulate, here, some hypotheses about the implications of sleep in general medicine. They result from the observation of some pathological situations which hold the medical thought process in check.
They concern numerous functional disorders (migraine, colics ...), and some charts situated on the border between psychology and physiology (like spasmophilia, fibromyalgia or the chronic fatigue syndrome).
These symptoms are disabling, capricious, worrying... but they all finally heal without sequellae.
Taking the implications of sleep in these still misunderstood pathologies into account should allow to restore the basis of a more constructive dialogue between doctor and patient.
The concept of functional sleep insufficiency that we suggest in the section about "general medicine and sleep", can help to take better care of a great variety of these disorders that have in common the clinical characteristics of an unefficient sleep.

Neologisms suggested by "Sleep and General Medicine" :
Somnology; Somnologist; Somnicology; Somnotoxic; Hypo-sleep; Somnosomatic; Hypo-sleep syndrome; Nap, user’s manual; Somnication; False True sick person; True False sick person.

These thoughts bring us to suggest the definition of a couple of new concepts :

  • Somnology:
    (or hypnology) [1]Medical specialization of recent appearance (1950, explorations of REM sleep, Pr. Dement in the United States and Pr. Jouvet in Lyon) which proposes to understand and take care of the sleep disorders.
    First confined to the sleep recording labs of the neurology units of the "CHU" (French term for a hospital associated to the local university), this science has developed its own identity in 1986 with the creation of the French Society of Sleep Research (SFRS).
    Even so, while sleep disorders are responsible for more mortality than cardiovascular diseases or cancers, somnology remains the poor relative of medical education and public health themes.
    In 2003, the authorities entered the process of recognizing the specialization with the creation of a specific section in the directories and the exclusive possibility of liberal practice for the owners of the diploma of the SFRS.
    2005 sees the creation of the ISV, Institute for Sleep and Vigilance), filiation of the new SFRMS ( French Society of Sleep Research and Medicine ) to put pressure on the authorities (with the financial support of the pharmaceutical companies).
    2007 : the health minister launches a "PAS" - program of action about sleep.
    To be continued ...

  • Somnologist:
    (or hypnologist) : physician of sleep and wake, or physician of sleepiness and arousal. (French national Inter-University diploma organized since 1986 by the sleep exploration labs and the SFRS, learned society).
    As it is stated clearly on their diploma, the somologists (or hypnologists) are specialized to understand and take care of the problems of sleepiness and insomnia.
    The problems of tiredness are often less familiar to them. These do not give cause to many publications while, in their daily (mainly hospital) practice, they do not meet the set of functional disorders that it causes (in our opinion).

  • "Somnicology" :
    The application of de rules of sleep medicine and chronobiology to the understanding and the treatment of functional disorders.
    A slightly futurist conception of somnology enlarged to the pathologies of general medicine. The lighting of the knowledge about sleep allows to take better care of the numerous diseases linked to tiredness (and often gives rise to a certain misunderstanding by the medical profession).
    Beyond the medical problems themselves, somnicology also extends to the management of life rythms in modern society.
    We think that tomorrow’s world presents, on that plan of the sleep-wake rythm, a true challenge that must be approached like solitary navigators. The reduction of the sleep duration is a plague of modern times. It has fallen from 9 hours in 1900 to seven hours and a half (even under five hours now in the US).

  • "Somnotoxic ":
    describes something that has the property to degrade sleep as well in a quantitative (television, Internet, video games, shift work...) as in a qualitative (events of life, jet-lag) manner.
    NB. The notion of "stress" is too limited when restrained to the "psychological" impact of an agression. In our opinion, the somnotoxic effect of the events of life shows (in case of decompensation) through functional disorders, independently from the moral suffering or anxiety (clearly, win the jackpot or marry one’s children is not considered like stress but can still end up in a lumbago).

  • "Hypo-sleep":
    Decompensation stage of a functional sleep insufficiency which expresses through the impossibility to recover strength when sleeping.
    The subject spends a lot of time resting and, in the start, even manages to sleep much more, but that sleep no longer provides the essential : rest and good shape. The sick person complains about a tiredness similar to that felt by an insomniac subject. (The same scores are obtained on the tiredness scales)
    • - In experimental conditions, a sleep deprived subject quickly suffers of sleepiness. He/she needs to sleep and falls asleep very quickly after one or two nights without sleeping.
    • - An insomniac subject feels sleep deprived because he/she is tired but cannot fall asleep easily because he/she is not sleepy.
    • In our opinion, insomnia could be an advanced form of the hypo-sleep syndrome where the sick person is no longer able to fall asleep by trying to get rest Cf. "Want to sleep".
    • Thus, the tiredness resulting of the hypo-sleep would be responsible for nocturnal arousals and not the opposite.

  • "Somnosomatic" :
    Describes all the symptoms that witness for a hypo-sleep situation in the process of decompensation. Through their function of alarm signs at all the stages of the illness, these symptoms are extremely varied (they are described as "ubiquitary" because they may concern any organ).
    They possess four common characteristics :
    • disabling : interruption of work, impossibility to get up, to move...(migraine, lumbago, dizziness ...)
    • capricious : desperating evolution depite the treatment and spontaneous remissions (miraculous, which gives rise to all sorts of "patamedicines" - a word inspired from another one, the pataphysics );
    • worrying : which gives cause to a spiral of consultations, complementary explorations and treatments that are very difficult to control and the source of iatrogenic complications.
    • and harmless: apart from the medical complications which are, unfortunately, very frequent (it is a pathology with a strong iatrogenic risk), the long term evolution is, in spite of all, excellent.

    Because of the absence of a detectable cause, they are often considered of "psycho-somatic" origin. It is then considered that the psychological ground is the engine of the symptoms.
    By définition, their intensity goes together with the degree of resistance, or of "deafness" of the sick person.
    Spontaneous recovery is the rule but some clinical forms that are disabling to 100% can be described as "malignant". ( COTOREP (Technical Commission for Professional Orientation and Reclassification), long term career interruption).

  • "Hypo-sleep syndrome":
    Gathering of the set of symptoms expressing signs of a functional sleep insufficiency. (The functional disorders, spasmophilia (or tetany), fibromyalgia and the chronic fatigue syndrome).
    Here, we formulate the hypothesis that a qualitative lack of sleep represents the physio-pathological mechanism common to all these symptoms which express signs of decompensation of the system.

  • "Somnications" :
    "Sleep is a medication". The understanding of the importance of the biological rythms and of the concept of hypo-sleep can open the way to a new form of treatment of the functional disorders.

    The main science-validated somnications are :

    • the nap;
    • the light;
    • the heat
    • sport;
    • food;
    • and more, like laughing, pleasure or love are still being studied...
      NB. Like all the active medications, the somnications may present undesirable side effects (somnotoxic).
      The nap, for example, can contribute to aggravate the tiredness (headaches, stiff neck ... ), it is totally contraindicated in insomnia.

  • Nap, user’s manual :
    The nap is a very powerful somnication that has to be handled with care.
    The "DiDal-smg, Dictionary of the Somnications" specifies all there is to know about its cautious and circumstancial use.
    Read the leaflet for the general public.
    Read the guide for good practice sheet designed for the health professionals

  • "False True-sick" :
    Someone who takes care of an illness erroneously made responsible for the somnosomatic functional disorders, which makes that he/she consumes a lot of medications and consults at loss for every new feeling of faintness.

  • "True False-sick":
    It is the misunderstood sick person : "the homeless of medicine". The one who suffers of somnosomatic functional disorders which, because they respond to no treatment, are labeled "psychosomatic" or imaginary.

  • Prayer of Maimonides:
    ... "Let me be contented in everything except in the great science of my profession.
    Never allow the thought to arise in me that I have attained to sufficient knowledge,
    but vouchsafe to me the strength, the leisure and the ambition ever to extend my knowledge.
    For art is great, but the mind of man is ever expanding.


[1We prefer the terms of somnology and somnologist, which are still absent from the dictionaries rather than "hypnology" and "hypnologist", which evoke, to our minds, too much the (quite limited) field of hypnosis (which is a transitional state of consciousness between wake and sleep).

Auteur | Contact | Copyleft | Traductions | derniere modif 31 August 2010.