February 9, 2015 • 28 mins
People were experiencing sleep disorders long before they were studied to the degree they are now. The first European account of narcolepsy appeared in the 1600s, but it would be well into the 19th century before the condition was researched.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class from how
Stuff Works dot com. Hello, and welcome to the podcast.
I'm Holly Frying and I'm Tracy D. Wilson. So I
have always been fascinated with sleep disorders, partially because absolutely
no one in my family is what you would categorize
(00:23):
as a regular sleeper. Like, growing up, if you woke
up at any hour of the day or night, there
was already someone awake in my house doing something. And
I grew up with insomnia. I had it for decades
and decades, and it sort of suddenly went away in
my mid thirties. And I know that sounds crazy when
I'm about to say, when I say what I'm about
to say, but I actually quite miss my insomnia. I think,
(00:44):
when that's your standard operating mode and then you don't
have it anymore, it just feels weird. I missed the
quiet time alone in my head. But today we're not
going to talk about insomnia, although it is going to
be mentioned in relation to narcilepsy, which is the topic
where a really covering and I kind of feel like
narcolepsy suffers from a similar problem in the public consciousness
(01:05):
as schizophrenia. UH. While schizoade behavior is often really incorrectly
conflated with other mental disorders, particularly multiple personality disorder UH
in film and television and even casual conversation. Narcolepsy is
often misrepresented in cultural shorthand as being the scenario where
someone just can't stay awake or is very sleepy. And
(01:27):
while sleepiness is certainly one of the symptoms of narcilepsy,
to describe it that way is a pretty serious oversimplification.
And additionally, sleep medicine has really only come into its
own in the last three decades or so. There were
was work being done before that, which is what we're
primarily going to talk about. But UH, people were experiencing
these sleep disorders long before they were studied to the
(01:49):
degree they are now, and so there was this whole
history of it. And you may remember that we talked
a little bit about sleepwalking during our Albert Terrell episode
almost two years ago, and in that one we mostly
discussed Terrell's lawyer using sleepwalking is a murder trial defense,
and the science around it was mostly contextual in terms
of how it did or did not match up with
Terrell's claims. UH. And in this episode, however, we're going
(02:12):
to go much deeper into sleep science and talk about
what narcailepsy is, how it was first identified at least
in the records we know, and how research continues to
reveal new information about it all the time. So the
time traveling science tale it ranges from the sixt right
up to present day. UH. But first we're going to
talk about what the disorder really is. And I will
(02:32):
put the caveat out there out of the gate that
the sources that we're working from here are pretty much
covering narcolepsy as it has been addressed and discussed in UH,
Europe and North America. There have certainly been other recognitions
of it, but in terms of like clinical papers that
I could access and read and UH study on it,
(02:55):
pretty much sticking to these UM. I would really love
to do a whole other episode or a series at
some point on sort of how different cultures view sleep
and sleep disorders, because, as I said, it's one of
those pet areas of mine. But today we're most sleep
sticking to kind of the Western approach. UH. And I
want to give one really quick note and trigger warning,
and it's really probably UM kind of an over being
(03:17):
overcautious with this. One of the earliest recorded cases that
we're going to talk about does involve a patient with
a history of sexual violence towards children. Uh So, if
that is an issue that you're sensitive to you or
one that you are not comfortable having a younger history
buff here about today. Heads up. It is a really
brief mention and it falls pretty late in this first
(03:39):
of two episodes. It's not going to be any sort
of detailed situation, and we'll give you another quick warning
as we come up to that point in the history,
so you can skip past it if you want to. It's,
like I said, it's pretty brief. So first up, we're
going to talk about what narcolepsy actually is. So if
you're not actually familiar with it, it's a brain disorder
that's characterized by sort of an out of wax sleep
(04:01):
wake cycle. Somebody with narcolepsy might have moments where they
do fall asleep in the middle of their normal activities,
and cataplexy, which I always want to call catalepsy, but
it is. Cataplexy is a common symptom of narcolepsy, and
this is actually the most specific symptom of the disorder,
as it's unusual for cataplexy to exist as a symptom
(04:21):
outside the presence of narcolepsy, and this involves an involuntary
and sudden loss of muscle control. Although the person is awake,
they are unable to move that you'll sometimes see it
referenced in UH documents as being a loss of muscle
tone as well. Narcoleptics may experience paralysis on either side
of the sleep cycle, and sometimes they have really vivid
(04:44):
hallucinations UH sometimes concurrent with this paralysis. It's not uncommon
at all for any person to actually experience some level
of sleep paralysis and really vivid imagery in their dreams.
It's pretty normal for this to occur during the rem
cycle of sleep. But whereas someone with a so called
normal sleep cycle would hit RAM at about ninety minutes
(05:05):
into sleep, somebody with narcilepsy hits RAM almost immediately when
they have an episode of sudden sleep. So this rapid
transition both entering and exiting sleep explains the symptoms of
hallucinations and paralysis, and it's also not uncommon for the
average person to experience sleep paralysis in some form when
(05:26):
they don't transition smoothly from deep sleep to wakefulness or
vice versa. I'm sure many of our listeners are like,
I've had that happen. Uh, so have I. But for
someone with a fairly regular sleep cycle, this really only
happens occasionally, But for narc eileptics this is a frequent
and persistent state of affairs. I think I remember one
time that happening to me in my life, and it
(05:48):
was scary, really, just the once once that I remember.
Like I said, I've had insomnia and some sleep issues forever,
so I have lots of instances of them, and I
was actually way into my adult years where I realized
like that I was not a freak like part of
me thought there was something really mentally wrong with me,
and I had never really talked to anybody about it
until one of my friends was talking about her sleep
(06:08):
paralysis and I was like, wait, other people have this,
which is shame on me for not doing the research. So,
despite sometimes dropping off to sleep during the day, narcileptics
don't usually get any more sleep than the average person
does in a twenty four hour cycle. And this is
because even when a person with narcolepsy is in bed
and able to frequently do the thing that might appear
(06:30):
to some that their body is constantly trying to do.
The quality of sleep that they get at that point
is extremely poor. It's punctuated by frequent periods of wakefulness.
And it's not uncommon for narcilepsy to be diagnosed in
tandem with other sleep disorders like sleep paralysis and insomnia.
I think that was the thing that tripped my really
(06:50):
trigger the first time I learned about narcolepsi was that
you could have narcolepsy and insomnia at the same time. Yeah.
It's also sometimes really difficult for narcolepts to be diagnosed
at all because most of the symptoms that are associated
with it can also come from other issues. Yeah. I
mean that's part of like sort of the tricky business
of sleep science, right, is that I'm not getting good
(07:12):
sleep is a common complaint for people with a lot
of different melodies. Um And you know, because it can
happen concurrently, like we just said, with insomnia, and in
this case, it's the type of insomnia where they really
don't have difficulty falling asleep, but they often wake up
from sleep quite frequently. Um. But narcilepsy is actually pretty common,
(07:33):
despite not always being diagnosed. It's estimated that about one
and three thousand Americans have narcolepsy with cataplexy, and researchers
believe that many more have non cataplexy narcilepsy. Those two
are are uh different, They're categorized differently, and these numbers
are only estimates because, as we said, uh, with many
(07:53):
sleep disorders, many instances of narcilepsy go undiagnosed. So what
we do know is that there's a pretty even split
between men and women. It doesn't seem to present in
any um particular racial population or culture any more than another.
It's it's pretty fair in how it distributes, and it
usually presents sometime in adolescence or early adulthood, although there
(08:17):
are certainly cases of it happening in children and in
people that are way past their early adulthood. Usually, cataplexy
is the first symptom to present in about ten p
of cases, and it's sometimes misdiagnosed as a caesuar disorder.
For a lot more people, Excessive daytime sleepiness or e
d S is the first symptom, and because many people
(08:37):
are leading busy lives and cutting back on sleep to
accommodate their to do list. It's really easy to chalk
up e d s to just getting too little sleep,
but it eventually can manifest into micro sleeps. So there's
our brief periods of very sudden sleep, sometimes only lasting
for a few seconds, during which the body just sort
of goes into an autopilot mode. During micro micro sleep,
(08:57):
a person might continue to perform the activity that he
or she was engaged in when the sleep episode hit,
but they're not usually aware of it and then have
no recollection of it later. Yeah, and it's you know,
sort of scary to think about because if you're driving
a car, you could have a microsleep and you'll keep
driving that car, but you won't be consciously aware of it. Uh.
(09:18):
A lot of times people pass through that cataplexy stage
where they are still aware before they doze off, but
they can't do anything and then they're just in sleep
really quickly. Uh. So there's some terrifying stuff to be
had around it. Um. You know, for some people, there
there are clinicians that will talk about their patients writing
notes and they doze off and they keep writing their note.
(09:40):
But of course it becomes scribbling scrawl, and it makes
no sense. But their their body is still doing the movements,
and it's still doing what it thinks is penmanship of
some sort. But it's just nonsense. Uh. Before we get
to the first appearance on record that we have, do
you want to have a quick word from a sponsor,
Let's do that. So while narcolepsy and other sleep just
orders undoubtedly existed for some time before any record of
(10:03):
them was set down, the first mention of a narcolepsy
or an ecilepsy like situation that we know of is
attributed to Dr Thomas Willis, and Willis, who was born
in sixty one, is often referred to as the father
of neuroscience. UH. He's most famous for his publication of
Cerebri Anatomy Brain anatomy text that described the nervous system
(10:24):
in a much more thorough and advanced way than any
writing that had preceded it. And he really promoted the
idea of taking a very methodical approach to brain analysis.
And he actually suggested that some flawed techniques on the
part of previous researchers had led to some incorrect conclusions
regarding anatomy and specifically that of the brain and nervous system.
(10:46):
While Willis didn't call the sleep condition, but he witnessed
narcilepsy in his sixteen seventy two writing the Anima Rotorum,
he described people who were likely to experience it this way,
a sleepy disposition. Eat and drink well, go abroad, take
care well enough of their domestic affairs. Yet whilst talking
or walking or eating, yea their mouth, their mouths being
(11:08):
full of meat, they shall nod, and, unless roused by others,
fall fast asleep. And what's interesting is that Willis suggested
in his notes again writing in sixteen seventy two, that
caffeine might be a suitable treatment for this, and in fact,
caffeine and other stimulants have been used in ourcilepsy treatment
throughout clinical history. Then we have a gap before we
(11:29):
see much more mention of this in the historical record,
and it's a pretty large gap. Yeah, there are some
mentions of narcalyptic type cases in the writings of several
doctors between the Willis description and the late eighteen hundreds
when a ecilepsy study re emerges with more information, but
there aren't a lot. And even so it's into the
eighteen hundreds before we really see them again. In eighteen
(11:50):
twenty nine, Heinrich Bruno Schindler included a description of what
sounds like an oarcilepsy and his publication Idiopathic Chronic Somnolence.
Let's book contains twenty different sleep disorder cases and begins
with one that was observed by doctor Johann Peter Frank,
who was a prominent physician working in the late seventeen
hundreds and early eighteen hundreds, and the case is laid
(12:13):
out as follows. Peter Frank mentioned a chief huntsman in
the Upland who had suffered from somnolence throughout eighty years
his whole life. He could not withstand the irresistible sleepiness
and fell asleep, even at table with the Prince, where
he poured too much more too much into the wineglass
while sleepy and stained the tablecloth. The son of the
man was also afflicted with the same somnolence at the
(12:35):
age of forty years. An eighteen thirty six account by
Dr Richard Bright, who's known to many as the father
of nephrology, also noted a seeming oarcalyptic condition and a
patient and then Irish surgeon Robert James Graves mentioned in
our Ecalyptic Case in his eighteen fifty one writing Observations
on the Nature and Treatment of Various Diseases. Pathologic sleepiness
(12:59):
is also been mentioned in the writing of French doctor
Mr Calf in eighteen sixty two when he detailed a
very sleepy patient, but notes made by doctor John Baptiste
Edward Jellanu who will talk about it just a bit,
suggest that Calf's patients may have actually been dealing with
an obstructive sleep afia rather than narc eclepsy. Yeah. Calf's
(13:22):
case involved a man who was forty seven years old,
and this man had to resign from his job because
his sleep urge was so great that he just could
not do his duties effectively. And the patient was described
with quote attitude detached, stupor mental sluggishness, persistent stoutness effect
on overall health as well as being puffy. And there's
(13:43):
no mention of cataplexy or sleep paralysis in this description,
and modern researchers believed that in this case the patient
probably was obese, as indicated by the description of his stoutness,
and as no treatment save a stay at a SPA
offered the man any relief. There's been some speculation in
the sleep research community that he may have lost weight
(14:04):
while he was the SPA, which can sometimes help those
who have obstructive sleep apnea, so it may or may
not qualify as an earcailepsy case. Calf's patient later had
a traumatic experience and the research that Holly found didn't
offer a clear indication of exactly what it was. Then
he fell into a state of sexual addiction and alcoholism
(14:25):
and he was treated for this by another doctor. Yeah,
and then he kind of disappears from the record in
terms of what what happened to him. And we're gonna
kind of jump into another word from a sponsor kind
of quickly, but that's because the next chunk is all
kind of juicy, and it's the research of one man,
and I want to keep it all together. So we
are going to have that word from a sponsor of
Tracy's down with that, Let's do it. So, uh, next
(14:48):
we get to one of the gentleman who's really kind
of uh masthead of this whole sleep disorder movement, in
particularly narcolepsy, and that's Earl Friedrich Otto Westfall, and he
was a German physician. He was born in eighteen thirty
three in Berlin, and he followed his father in terms
(15:09):
of his career choice when he went to medicine. His
father was also a doctor, and Westfall studied medicine in
schools throughout Europe. He eventually joined the Berlin Charite Hospital
as a member of the smallpox team there, and a
year later he actually made the switch from the smallpox
ward to working with mentally ill patients, and he eventually
became a professor of psychiatry in eighteen seventy four. Westpall
(15:33):
is often cited for his work in agoraphobia, which he
wrote about just extensively starting in eighteen seventy one. This
is more than a century before agoraphobia would end up
in the Diagnostic and Statistical Manual of Mental Disorders, which
is the thing that's often used to sort of categorize
different uh disorders. Yeah, you'll sometimes see those headlines of
(15:54):
like this was added to the d s M, or
this was taken out of the d s M, and
that's that's where we're talking about. Uh. Westphall was also
one of the first doctors to study homosexuality, but that
term had not even been coined when he was doing
his work, and he instead called same sex attraction quote
the contrary sexual feeling, and that was indicating his assessment
(16:14):
of it as a contradiction between the mind's desire and
the body's anatomy, and he felt that as such it
was a condition which should be cared for from a
psychiatric standpoint rather than being dealt with through the legal
system as a crime. In eighteen seventy seven, Westpall presented
two different cases before the attendees of the Berlin Medical
and Psychological Society meeting, and the first was about epilepsy.
(16:38):
The second focused on a patient with cataplexy and his patient,
who was a bookbinder named Alert, had experienced two different
phenomena which Westpall discussed at length. First, he did not
lose consciousness during these incidents of the loss of muscle control,
so that's in line with what we've describe as catoplexy today.
And second, this patient had persistent insomnia. So these uh,
(17:02):
that was you've just listened to our first part where
we kind of broke down what insomnia is. These are
two very common elements of narcolepsi diagnoses. Taylor was first
admitted to the Berlin Charity Hospital on July seventy one.
The Bookbinder claimed that several months before he was admitted,
he had a fit of anger, which caused him to
(17:23):
become ill. He lost his job after a fight with
a coworker, then got out for drinks, and then went home,
where his wife yelled at him. At that point, he
had a short episode of sixty to nineties seconds during
which he couldn't speak, trembled, and had to sit down.
And though he remained somewhat agitated throughout that evening, Alert
(17:43):
reported that he slept well that night, but after this incident,
even slight stimulation would cause another so called fit uh.
The degree of muscle weakness that he would be struck
with when these moments overtook him grew in severity as
the attacks continued. Westpall was the first position to explore
an ourcilepsy with the common accompanying cataplexy, and he also
(18:06):
examined the possibility of some kind of genetic factor in
cataplectic patients that it could be inherited. The mother of
his patient in this case had a history of it.
Throughout her life. Although hers had decreased in its severity
as she got older, her symptoms didn't start to happen
until she had an accident in which she was struck
by a brick. However, and the patient in west Fall's case,
(18:30):
while he primarily talks about cataplexy, also had sleep attacks,
and these would happen Westall seemed to think as a
result of the cataplexy, So these events would sometimes happen
when the patient was quote strolling around quietly and aimlessly.
Here's how Westpall describes Alert's episodes. I've had the opportunity
(18:51):
to observe the attacks and the patient himself on repeated occasions.
He had one of these attacks while I was engaged
in conversation with him. While he was still speaking, one
could see that a certain change had occurred in his face.
Facial coloration is up, where eyelids lowered gradually, like those
of a person falling asleep, during which the eyes roll upward.
Then they opened again once or twice, seemingly with great effort,
(19:14):
until they finally shut completely, whereupon the patient stopped speaking
after murmuring something incomprehensible, his head sank down to his
chest and his brow seemed forcefully knit. Small sporadic nostril
contractions were observable, and the patient's appearance was that of
a seated person asleep. After a short time, several minutes,
(19:34):
the eyebrows relaxed, the patient raised his right arm a
few times, he's stretching upward, and rubbed his eyes sleepily,
like one awaking from slumber. The scene then repeated itself
all over again, during which one could observe that, though
apparently asleep, the patient hears is what if one addresses him,
Since he nods in response to questions directed to him afterwards,
(19:55):
he also knows everything that was said during the time. Yeah,
and that's a little it different in that our modern
research suggests that like people, right up to the point
where they hit microsleep, they may have consciousness, but there
is this gap in their recollection of what happens during
these micro sleeps. So that's just a little different thing
that I wanted to point out. Ailor's condition also caused
(20:16):
him a little bit of trouble on occasion. There was
one point where he was mistaken for being drunk while
he was working as a porter and a policeman was called,
and when he recovered from his attack, he of course
became his normal self. He was completely uh cogent and aware,
and he was able to explain that no, no, in fact,
he had a medical condition. When Ailert had an attack,
(20:38):
his eyes closed in voluntarily. They could only be opened
with great effort if he was able to do so.
He only saw bright light. He also reported not feeling
tired before these attacks and described the pre event mental
state as his mind being empty or wandering completely. No
dizziness accompanied them. So remember west Ball is describing cataplexy
(20:59):
at this point, and then he goes on to say
that alert instances of sleep are an extension of the
muscular condition. And while Westpall did not use the terms
catoplexy or an ecilepsy in his presentation or in the
related writings that he worked on afterwards, he was clearly
describing the same symptoms. And as we said, his work
also focused so much more on the cataplexy than the
(21:21):
narcileptic sleep attacks. So while he was clearly onto the disorder,
he didn't identify it as one unique condition unto itself
quite yet. As for the lack of a name for
what he had witnessed in his patient alert, Westpall wrote,
one is faced with a predicament in attempting to attribute
a name to the illness described above. It would be
a simple matter to call these episodes epileptoid attacks as well,
(21:44):
and I cannot object to the term if one wishes
to lengthen the list of very varied conditions commonly called
by that name. This does not advance our understanding it all, however,
and the peculiarity of the attacks to which I need
not add any further detail given the exhaustive description and above,
persists nonetheless. And then, almost as a footnote, Westfall mentions
(22:07):
another case he consulted on several years earlier, and it
really is like a footnote. He goes on and on
and on about Tailor, and then it's like two paragraphs
on this one. And this is our trigger warning section.
This is the case that we mentioned at the top
of the episode that involves some unsettling content. We're not
going into any details, and it will take us less
than a minute to talk about it. So if you
want to hop ahead, now is the time. So several
(22:28):
years prior to his work with Ailort, Westball had been
asked to collaborate in determining the mental state of a
recently arrested criminal. The man who was named von Zastrow
had raped and attempted to murder a young boy. Westwall
had expected, based on the information that he had been given,
to find that von Sastrow had epilepsy. None was indicated,
(22:49):
but the prisoner did relay that he would often fall
asleep in social situation, so that he had been mocked
for doing so. Von Zastrows suspected that this constant drowsiness
might be the result of his addiction to masturbation. Yeah,
this caused some confusion, uh, you know about sort of
being associated with uh, sexual deviance or something like that.
(23:11):
But Westfall concludes his paper by talking about this tale,
and he says that he was reminded of this case
while working on the instance of you know, putting together
his notes to relay alert's condition, and he writes, quote,
one cannot deny that if additional observation should uncover a
fairly common occurrence of such sleep attacks, then we are
in the presence of a pathological manifestation of the nervous system, which,
(23:35):
in the exploration of the mental condition of certain categories
of criminals deserves no less consideration than epileptic or epileptoid attacks.
It is evident that for the time being, nothing less
than a disease of the central nervous system can be concluded,
and that the question of responsibility in and of itself
is not involved. So at this point, the medical community
(23:56):
is really on the cusp of recognizing narcolepsy as an
actual met cold condition, and that is where we're going
to stop. Yeah, so we can get to part two,
which is where the next big, uh huge part of
identification and research comes in. Uh So hopefully you will not.
I had to chuckle to myself as I was doing
(24:17):
some of this research because I was thinking, I hope
none of our listeners start hearing these symptoms and go,
maybe I have not gilepsy the way that first year
med students always do. I'm more when uh at the start,
when we were talking about symptoms, I was like, this
sounds a lot like sleep sleep apnia, And then we
got to the part where we talked about sleep apnia
and I was like, yeah, yeah, that's like we said,
there are so many commonalities amongst different sleep disorders that
(24:40):
it really does cost some trickiness in terms of identifying
some of them. Particularly at this point in time, and
even up until like the mid twentieth century when they
were really developing identifying test procedures, it was easy for
people to kind of get written off or misdiagnosed. And
we'll talk about that some more in episode two. Now
(25:01):
I have listener mail. Uh, this is a correction on
our Gouty episode. We got a couple of these, and
I will talk about it a little bit, uh, and
I will laugh at myself. So, uh, this is from
our listener, Kevin. He says, I wanted to provide you
with a small but important to me correction regarding your
comment comments on Gouty's podification. One of you mentioned that
(25:22):
members of the society promoting Gouty's beatification quote already believed
in Gouty's divinity. That was mine. It was a misspeak
on my part. I made a quick search for this
group and found what I believed is your website, but
it was in Spanish, but I cannot read. I'm gonna
jump ahead, uh. She he says. Furthermore, if they are Catholic,
familiar with their faith, which I presume to be true,
they would not believe that Gouty was divine. Individuals named
(25:45):
a saint by the Catholic Church are considered to have
had lives of heroic virtue and are to be considered
examples of how to live a good life in accordance
with God's will. The Holy Spirit of God is considered
to have acted within these individuals. However, these individuals are
not considered to be mine in the sense that they
themselves are a God, are directly part of God, rather
than the Holy Spirit inspired these individuals. We got a
(26:07):
couple of these, one of which kind of accused me
of having been raised with some sort of anti Catholic sentiment,
and I had to chuckle a little bit. Not that
it's not a valid comment and a valid correction to make,
but because uh, I have a lot of relatives who
I would have to apologize to if that were the case,
because my mother Shute of the family is very devout
Roman Catholic, and I was raised Catholic. This is just
(26:29):
a case where I misspoke, you know, sometimes notes are
getting written in the middle of the night. I certainly
would not mean to um uh in any way mock
or misrepresent anybody's religion, but it did strike me as
funny that people thought I might be anti Catholic because
I grew up very very well. I'm just I'm just
forgetful and sometimes I just speak extemporariously and it's not
(26:50):
always correct. Yeah, well, and sometimes always came to uh.
They were worded in such a way that they sort
of sounded like maybe you had never heard of Catholicism,
which really did make me laugh, because I mean, I
have like clergy in my family, like there's so it
was a chuckle. And again, I don't mean to in
any way downplay the import of their their feelings on
the matter, but it's just the juxtaposition between what they
(27:14):
thought might be going on and what my actual upbringing
was was so completely at odds that it was a
little bit comedic to me. That's all so apologies. If
anybody was confused or dismayed by those comments, I'm telling
you you can be raised Catholic and still say their
own thing. If you would like to write to us
about today's episode or anything else that pops to your mind,
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(27:35):
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(27:57):
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(28:17):
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Welcome to Stuff You Missed in History Class from how
Stuff Works dot com. Hello, and welcome to the podcast.
I'm Holly Frying and I'm Tracy D. Wilson. So I
have always been fascinated with sleep disorders, partially because absolutely
no one in my family is what you would categorize
(00:23):
as a regular sleeper. Like, growing up, if you woke
up at any hour of the day or night, there
was already someone awake in my house doing something. And
I grew up with insomnia. I had it for decades
and decades, and it sort of suddenly went away in
my mid thirties. And I know that sounds crazy when
I'm about to say, when I say what I'm about
to say, but I actually quite miss my insomnia. I think,
(00:44):
when that's your standard operating mode and then you don't
have it anymore, it just feels weird. I missed the
quiet time alone in my head. But today we're not
going to talk about insomnia, although it is going to
be mentioned in relation to narcilepsy, which is the topic
where a really covering and I kind of feel like
narcolepsy suffers from a similar problem in the public consciousness
(01:05):
as schizophrenia. UH. While schizoade behavior is often really incorrectly
conflated with other mental disorders, particularly multiple personality disorder UH
in film and television and even casual conversation. Narcolepsy is
often misrepresented in cultural shorthand as being the scenario where
someone just can't stay awake or is very sleepy. And
(01:27):
while sleepiness is certainly one of the symptoms of narcilepsy,
to describe it that way is a pretty serious oversimplification.
And additionally, sleep medicine has really only come into its
own in the last three decades or so. There were
was work being done before that, which is what we're
primarily going to talk about. But UH, people were experiencing
these sleep disorders long before they were studied to the
(01:49):
degree they are now, and so there was this whole
history of it. And you may remember that we talked
a little bit about sleepwalking during our Albert Terrell episode
almost two years ago, and in that one we mostly
discussed Terrell's lawyer using sleepwalking is a murder trial defense,
and the science around it was mostly contextual in terms
of how it did or did not match up with
Terrell's claims. UH. And in this episode, however, we're going
(02:12):
to go much deeper into sleep science and talk about
what narcailepsy is, how it was first identified at least
in the records we know, and how research continues to
reveal new information about it all the time. So the
time traveling science tale it ranges from the sixt right
up to present day. UH. But first we're going to
talk about what the disorder really is. And I will
(02:32):
put the caveat out there out of the gate that
the sources that we're working from here are pretty much
covering narcolepsy as it has been addressed and discussed in UH,
Europe and North America. There have certainly been other recognitions
of it, but in terms of like clinical papers that
I could access and read and UH study on it,
(02:55):
pretty much sticking to these UM. I would really love
to do a whole other episode or a series at
some point on sort of how different cultures view sleep
and sleep disorders, because, as I said, it's one of
those pet areas of mine. But today we're most sleep
sticking to kind of the Western approach. UH. And I
want to give one really quick note and trigger warning,
and it's really probably UM kind of an over being
(03:17):
overcautious with this. One of the earliest recorded cases that
we're going to talk about does involve a patient with
a history of sexual violence towards children. Uh So, if
that is an issue that you're sensitive to you or
one that you are not comfortable having a younger history
buff here about today. Heads up. It is a really
brief mention and it falls pretty late in this first
(03:39):
of two episodes. It's not going to be any sort
of detailed situation, and we'll give you another quick warning
as we come up to that point in the history,
so you can skip past it if you want to. It's,
like I said, it's pretty brief. So first up, we're
going to talk about what narcolepsy actually is. So if
you're not actually familiar with it, it's a brain disorder
that's characterized by sort of an out of wax sleep
(04:01):
wake cycle. Somebody with narcolepsy might have moments where they
do fall asleep in the middle of their normal activities,
and cataplexy, which I always want to call catalepsy, but
it is. Cataplexy is a common symptom of narcolepsy, and
this is actually the most specific symptom of the disorder,
as it's unusual for cataplexy to exist as a symptom
(04:21):
outside the presence of narcolepsy, and this involves an involuntary
and sudden loss of muscle control. Although the person is awake,
they are unable to move that you'll sometimes see it
referenced in UH documents as being a loss of muscle
tone as well. Narcoleptics may experience paralysis on either side
of the sleep cycle, and sometimes they have really vivid
(04:44):
hallucinations UH sometimes concurrent with this paralysis. It's not uncommon
at all for any person to actually experience some level
of sleep paralysis and really vivid imagery in their dreams.
It's pretty normal for this to occur during the rem
cycle of sleep. But whereas someone with a so called
normal sleep cycle would hit RAM at about ninety minutes
(05:05):
into sleep, somebody with narcilepsy hits RAM almost immediately when
they have an episode of sudden sleep. So this rapid
transition both entering and exiting sleep explains the symptoms of
hallucinations and paralysis, and it's also not uncommon for the
average person to experience sleep paralysis in some form when
(05:26):
they don't transition smoothly from deep sleep to wakefulness or
vice versa. I'm sure many of our listeners are like,
I've had that happen. Uh, so have I. But for
someone with a fairly regular sleep cycle, this really only
happens occasionally, But for narc eileptics this is a frequent
and persistent state of affairs. I think I remember one
time that happening to me in my life, and it
(05:48):
was scary, really, just the once once that I remember.
Like I said, I've had insomnia and some sleep issues forever,
so I have lots of instances of them, and I
was actually way into my adult years where I realized
like that I was not a freak like part of
me thought there was something really mentally wrong with me,
and I had never really talked to anybody about it
until one of my friends was talking about her sleep
(06:08):
paralysis and I was like, wait, other people have this,
which is shame on me for not doing the research. So,
despite sometimes dropping off to sleep during the day, narcileptics
don't usually get any more sleep than the average person
does in a twenty four hour cycle. And this is
because even when a person with narcolepsy is in bed
and able to frequently do the thing that might appear
(06:30):
to some that their body is constantly trying to do.
The quality of sleep that they get at that point
is extremely poor. It's punctuated by frequent periods of wakefulness.
And it's not uncommon for narcilepsy to be diagnosed in
tandem with other sleep disorders like sleep paralysis and insomnia.
I think that was the thing that tripped my really
(06:50):
trigger the first time I learned about narcolepsi was that
you could have narcolepsy and insomnia at the same time. Yeah.
It's also sometimes really difficult for narcolepts to be diagnosed
at all because most of the symptoms that are associated
with it can also come from other issues. Yeah. I
mean that's part of like sort of the tricky business
of sleep science, right, is that I'm not getting good
(07:12):
sleep is a common complaint for people with a lot
of different melodies. Um And you know, because it can
happen concurrently, like we just said, with insomnia, and in
this case, it's the type of insomnia where they really
don't have difficulty falling asleep, but they often wake up
from sleep quite frequently. Um. But narcilepsy is actually pretty common,
(07:33):
despite not always being diagnosed. It's estimated that about one
and three thousand Americans have narcolepsy with cataplexy, and researchers
believe that many more have non cataplexy narcilepsy. Those two
are are uh different, They're categorized differently, and these numbers
are only estimates because, as we said, uh, with many
(07:53):
sleep disorders, many instances of narcilepsy go undiagnosed. So what
we do know is that there's a pretty even split
between men and women. It doesn't seem to present in
any um particular racial population or culture any more than another.
It's it's pretty fair in how it distributes, and it
usually presents sometime in adolescence or early adulthood, although there
(08:17):
are certainly cases of it happening in children and in
people that are way past their early adulthood. Usually, cataplexy
is the first symptom to present in about ten p
of cases, and it's sometimes misdiagnosed as a caesuar disorder.
For a lot more people, Excessive daytime sleepiness or e
d S is the first symptom, and because many people
(08:37):
are leading busy lives and cutting back on sleep to
accommodate their to do list. It's really easy to chalk
up e d s to just getting too little sleep,
but it eventually can manifest into micro sleeps. So there's
our brief periods of very sudden sleep, sometimes only lasting
for a few seconds, during which the body just sort
of goes into an autopilot mode. During micro micro sleep,
(08:57):
a person might continue to perform the activity that he
or she was engaged in when the sleep episode hit,
but they're not usually aware of it and then have
no recollection of it later. Yeah, and it's you know,
sort of scary to think about because if you're driving
a car, you could have a microsleep and you'll keep
driving that car, but you won't be consciously aware of it. Uh.
(09:18):
A lot of times people pass through that cataplexy stage
where they are still aware before they doze off, but
they can't do anything and then they're just in sleep
really quickly. Uh. So there's some terrifying stuff to be
had around it. Um. You know, for some people, there
there are clinicians that will talk about their patients writing
notes and they doze off and they keep writing their note.
(09:40):
But of course it becomes scribbling scrawl, and it makes
no sense. But their their body is still doing the movements,
and it's still doing what it thinks is penmanship of
some sort. But it's just nonsense. Uh. Before we get
to the first appearance on record that we have, do
you want to have a quick word from a sponsor,
Let's do that. So while narcolepsy and other sleep just
orders undoubtedly existed for some time before any record of
(10:03):
them was set down, the first mention of a narcolepsy
or an ecilepsy like situation that we know of is
attributed to Dr Thomas Willis, and Willis, who was born
in sixty one, is often referred to as the father
of neuroscience. UH. He's most famous for his publication of
Cerebri Anatomy Brain anatomy text that described the nervous system
(10:24):
in a much more thorough and advanced way than any
writing that had preceded it. And he really promoted the
idea of taking a very methodical approach to brain analysis.
And he actually suggested that some flawed techniques on the
part of previous researchers had led to some incorrect conclusions
regarding anatomy and specifically that of the brain and nervous system.
(10:46):
While Willis didn't call the sleep condition, but he witnessed
narcilepsy in his sixteen seventy two writing the Anima Rotorum,
he described people who were likely to experience it this way,
a sleepy disposition. Eat and drink well, go abroad, take
care well enough of their domestic affairs. Yet whilst talking
or walking or eating, yea their mouth, their mouths being
(11:08):
full of meat, they shall nod, and, unless roused by others,
fall fast asleep. And what's interesting is that Willis suggested
in his notes again writing in sixteen seventy two, that
caffeine might be a suitable treatment for this, and in fact,
caffeine and other stimulants have been used in ourcilepsy treatment
throughout clinical history. Then we have a gap before we
(11:29):
see much more mention of this in the historical record,
and it's a pretty large gap. Yeah, there are some
mentions of narcalyptic type cases in the writings of several
doctors between the Willis description and the late eighteen hundreds
when a ecilepsy study re emerges with more information, but
there aren't a lot. And even so it's into the
eighteen hundreds before we really see them again. In eighteen
(11:50):
twenty nine, Heinrich Bruno Schindler included a description of what
sounds like an oarcilepsy and his publication Idiopathic Chronic Somnolence.
Let's book contains twenty different sleep disorder cases and begins
with one that was observed by doctor Johann Peter Frank,
who was a prominent physician working in the late seventeen
hundreds and early eighteen hundreds, and the case is laid
(12:13):
out as follows. Peter Frank mentioned a chief huntsman in
the Upland who had suffered from somnolence throughout eighty years
his whole life. He could not withstand the irresistible sleepiness
and fell asleep, even at table with the Prince, where
he poured too much more too much into the wineglass
while sleepy and stained the tablecloth. The son of the
man was also afflicted with the same somnolence at the
(12:35):
age of forty years. An eighteen thirty six account by
Dr Richard Bright, who's known to many as the father
of nephrology, also noted a seeming oarcalyptic condition and a
patient and then Irish surgeon Robert James Graves mentioned in
our Ecalyptic Case in his eighteen fifty one writing Observations
on the Nature and Treatment of Various Diseases. Pathologic sleepiness
(12:59):
is also been mentioned in the writing of French doctor
Mr Calf in eighteen sixty two when he detailed a
very sleepy patient, but notes made by doctor John Baptiste
Edward Jellanu who will talk about it just a bit,
suggest that Calf's patients may have actually been dealing with
an obstructive sleep afia rather than narc eclepsy. Yeah. Calf's
(13:22):
case involved a man who was forty seven years old,
and this man had to resign from his job because
his sleep urge was so great that he just could
not do his duties effectively. And the patient was described
with quote attitude detached, stupor mental sluggishness, persistent stoutness effect
on overall health as well as being puffy. And there's
(13:43):
no mention of cataplexy or sleep paralysis in this description,
and modern researchers believed that in this case the patient
probably was obese, as indicated by the description of his stoutness,
and as no treatment save a stay at a SPA
offered the man any relief. There's been some speculation in
the sleep research community that he may have lost weight
(14:04):
while he was the SPA, which can sometimes help those
who have obstructive sleep apnea, so it may or may
not qualify as an earcailepsy case. Calf's patient later had
a traumatic experience and the research that Holly found didn't
offer a clear indication of exactly what it was. Then
he fell into a state of sexual addiction and alcoholism
(14:25):
and he was treated for this by another doctor. Yeah,
and then he kind of disappears from the record in
terms of what what happened to him. And we're gonna
kind of jump into another word from a sponsor kind
of quickly, but that's because the next chunk is all
kind of juicy, and it's the research of one man,
and I want to keep it all together. So we
are going to have that word from a sponsor of
Tracy's down with that, Let's do it. So, uh, next
(14:48):
we get to one of the gentleman who's really kind
of uh masthead of this whole sleep disorder movement, in
particularly narcolepsy, and that's Earl Friedrich Otto Westfall, and he
was a German physician. He was born in eighteen thirty
three in Berlin, and he followed his father in terms
(15:09):
of his career choice when he went to medicine. His
father was also a doctor, and Westfall studied medicine in
schools throughout Europe. He eventually joined the Berlin Charite Hospital
as a member of the smallpox team there, and a
year later he actually made the switch from the smallpox
ward to working with mentally ill patients, and he eventually
became a professor of psychiatry in eighteen seventy four. Westpall
(15:33):
is often cited for his work in agoraphobia, which he
wrote about just extensively starting in eighteen seventy one. This
is more than a century before agoraphobia would end up
in the Diagnostic and Statistical Manual of Mental Disorders, which
is the thing that's often used to sort of categorize
different uh disorders. Yeah, you'll sometimes see those headlines of
(15:54):
like this was added to the d s M, or
this was taken out of the d s M, and
that's that's where we're talking about. Uh. Westphall was also
one of the first doctors to study homosexuality, but that
term had not even been coined when he was doing
his work, and he instead called same sex attraction quote
the contrary sexual feeling, and that was indicating his assessment
(16:14):
of it as a contradiction between the mind's desire and
the body's anatomy, and he felt that as such it
was a condition which should be cared for from a
psychiatric standpoint rather than being dealt with through the legal
system as a crime. In eighteen seventy seven, Westpall presented
two different cases before the attendees of the Berlin Medical
and Psychological Society meeting, and the first was about epilepsy.
(16:38):
The second focused on a patient with cataplexy and his patient,
who was a bookbinder named Alert, had experienced two different
phenomena which Westpall discussed at length. First, he did not
lose consciousness during these incidents of the loss of muscle control,
so that's in line with what we've describe as catoplexy today.
And second, this patient had persistent insomnia. So these uh,
(17:02):
that was you've just listened to our first part where
we kind of broke down what insomnia is. These are
two very common elements of narcolepsi diagnoses. Taylor was first
admitted to the Berlin Charity Hospital on July seventy one.
The Bookbinder claimed that several months before he was admitted,
he had a fit of anger, which caused him to
(17:23):
become ill. He lost his job after a fight with
a coworker, then got out for drinks, and then went home,
where his wife yelled at him. At that point, he
had a short episode of sixty to nineties seconds during
which he couldn't speak, trembled, and had to sit down.
And though he remained somewhat agitated throughout that evening, Alert
(17:43):
reported that he slept well that night, but after this incident,
even slight stimulation would cause another so called fit uh.
The degree of muscle weakness that he would be struck
with when these moments overtook him grew in severity as
the attacks continued. Westpall was the first position to explore
an ourcilepsy with the common accompanying cataplexy, and he also
(18:06):
examined the possibility of some kind of genetic factor in
cataplectic patients that it could be inherited. The mother of
his patient in this case had a history of it.
Throughout her life. Although hers had decreased in its severity
as she got older, her symptoms didn't start to happen
until she had an accident in which she was struck
by a brick. However, and the patient in west Fall's case,
(18:30):
while he primarily talks about cataplexy, also had sleep attacks,
and these would happen Westall seemed to think as a
result of the cataplexy, So these events would sometimes happen
when the patient was quote strolling around quietly and aimlessly.
Here's how Westpall describes Alert's episodes. I've had the opportunity
(18:51):
to observe the attacks and the patient himself on repeated occasions.
He had one of these attacks while I was engaged
in conversation with him. While he was still speaking, one
could see that a certain change had occurred in his face.
Facial coloration is up, where eyelids lowered gradually, like those
of a person falling asleep, during which the eyes roll upward.
Then they opened again once or twice, seemingly with great effort,
(19:14):
until they finally shut completely, whereupon the patient stopped speaking
after murmuring something incomprehensible, his head sank down to his
chest and his brow seemed forcefully knit. Small sporadic nostril
contractions were observable, and the patient's appearance was that of
a seated person asleep. After a short time, several minutes,
(19:34):
the eyebrows relaxed, the patient raised his right arm a
few times, he's stretching upward, and rubbed his eyes sleepily,
like one awaking from slumber. The scene then repeated itself
all over again, during which one could observe that, though
apparently asleep, the patient hears is what if one addresses him,
Since he nods in response to questions directed to him afterwards,
(19:55):
he also knows everything that was said during the time. Yeah,
and that's a little it different in that our modern
research suggests that like people, right up to the point
where they hit microsleep, they may have consciousness, but there
is this gap in their recollection of what happens during
these micro sleeps. So that's just a little different thing
that I wanted to point out. Ailor's condition also caused
(20:16):
him a little bit of trouble on occasion. There was
one point where he was mistaken for being drunk while
he was working as a porter and a policeman was called,
and when he recovered from his attack, he of course
became his normal self. He was completely uh cogent and aware,
and he was able to explain that no, no, in fact,
he had a medical condition. When Ailert had an attack,
(20:38):
his eyes closed in voluntarily. They could only be opened
with great effort if he was able to do so.
He only saw bright light. He also reported not feeling
tired before these attacks and described the pre event mental
state as his mind being empty or wandering completely. No
dizziness accompanied them. So remember west Ball is describing cataplexy
(20:59):
at this point, and then he goes on to say
that alert instances of sleep are an extension of the
muscular condition. And while Westpall did not use the terms
catoplexy or an ecilepsy in his presentation or in the
related writings that he worked on afterwards, he was clearly
describing the same symptoms. And as we said, his work
also focused so much more on the cataplexy than the
(21:21):
narcileptic sleep attacks. So while he was clearly onto the disorder,
he didn't identify it as one unique condition unto itself
quite yet. As for the lack of a name for
what he had witnessed in his patient alert, Westpall wrote,
one is faced with a predicament in attempting to attribute
a name to the illness described above. It would be
a simple matter to call these episodes epileptoid attacks as well,
(21:44):
and I cannot object to the term if one wishes
to lengthen the list of very varied conditions commonly called
by that name. This does not advance our understanding it all, however,
and the peculiarity of the attacks to which I need
not add any further detail given the exhaustive description and above,
persists nonetheless. And then, almost as a footnote, Westfall mentions
(22:07):
another case he consulted on several years earlier, and it
really is like a footnote. He goes on and on
and on about Tailor, and then it's like two paragraphs
on this one. And this is our trigger warning section.
This is the case that we mentioned at the top
of the episode that involves some unsettling content. We're not
going into any details, and it will take us less
than a minute to talk about it. So if you
want to hop ahead, now is the time. So several
(22:28):
years prior to his work with Ailort, Westball had been
asked to collaborate in determining the mental state of a
recently arrested criminal. The man who was named von Zastrow
had raped and attempted to murder a young boy. Westwall
had expected, based on the information that he had been given,
to find that von Sastrow had epilepsy. None was indicated,
(22:49):
but the prisoner did relay that he would often fall
asleep in social situation, so that he had been mocked
for doing so. Von Zastrows suspected that this constant drowsiness
might be the result of his addiction to masturbation. Yeah,
this caused some confusion, uh, you know about sort of
being associated with uh, sexual deviance or something like that.
(23:11):
But Westfall concludes his paper by talking about this tale,
and he says that he was reminded of this case
while working on the instance of you know, putting together
his notes to relay alert's condition, and he writes, quote,
one cannot deny that if additional observation should uncover a
fairly common occurrence of such sleep attacks, then we are
in the presence of a pathological manifestation of the nervous system, which,
(23:35):
in the exploration of the mental condition of certain categories
of criminals deserves no less consideration than epileptic or epileptoid attacks.
It is evident that for the time being, nothing less
than a disease of the central nervous system can be concluded,
and that the question of responsibility in and of itself
is not involved. So at this point, the medical community
(23:56):
is really on the cusp of recognizing narcolepsy as an
actual met cold condition, and that is where we're going
to stop. Yeah, so we can get to part two,
which is where the next big, uh huge part of
identification and research comes in. Uh So hopefully you will not.
I had to chuckle to myself as I was doing
(24:17):
some of this research because I was thinking, I hope
none of our listeners start hearing these symptoms and go,
maybe I have not gilepsy the way that first year
med students always do. I'm more when uh at the start,
when we were talking about symptoms, I was like, this
sounds a lot like sleep sleep apnia, And then we
got to the part where we talked about sleep apnia
and I was like, yeah, yeah, that's like we said,
there are so many commonalities amongst different sleep disorders that
(24:40):
it really does cost some trickiness in terms of identifying
some of them. Particularly at this point in time, and
even up until like the mid twentieth century when they
were really developing identifying test procedures, it was easy for
people to kind of get written off or misdiagnosed. And
we'll talk about that some more in episode two. Now
(25:01):
I have listener mail. Uh, this is a correction on
our Gouty episode. We got a couple of these, and
I will talk about it a little bit, uh, and
I will laugh at myself. So, uh, this is from
our listener, Kevin. He says, I wanted to provide you
with a small but important to me correction regarding your
comment comments on Gouty's podification. One of you mentioned that
(25:22):
members of the society promoting Gouty's beatification quote already believed
in Gouty's divinity. That was mine. It was a misspeak
on my part. I made a quick search for this
group and found what I believed is your website, but
it was in Spanish, but I cannot read. I'm gonna
jump ahead, uh. She he says. Furthermore, if they are Catholic,
familiar with their faith, which I presume to be true,
they would not believe that Gouty was divine. Individuals named
(25:45):
a saint by the Catholic Church are considered to have
had lives of heroic virtue and are to be considered
examples of how to live a good life in accordance
with God's will. The Holy Spirit of God is considered
to have acted within these individuals. However, these individuals are
not considered to be mine in the sense that they
themselves are a God, are directly part of God, rather
than the Holy Spirit inspired these individuals. We got a
(26:07):
couple of these, one of which kind of accused me
of having been raised with some sort of anti Catholic sentiment,
and I had to chuckle a little bit. Not that
it's not a valid comment and a valid correction to make,
but because uh, I have a lot of relatives who
I would have to apologize to if that were the case,
because my mother Shute of the family is very devout
Roman Catholic, and I was raised Catholic. This is just
(26:29):
a case where I misspoke, you know, sometimes notes are
getting written in the middle of the night. I certainly
would not mean to um uh in any way mock
or misrepresent anybody's religion, but it did strike me as
funny that people thought I might be anti Catholic because
I grew up very very well. I'm just I'm just
forgetful and sometimes I just speak extemporariously and it's not
(26:50):
always correct. Yeah, well, and sometimes always came to uh.
They were worded in such a way that they sort
of sounded like maybe you had never heard of Catholicism,
which really did make me laugh, because I mean, I
have like clergy in my family, like there's so it
was a chuckle. And again, I don't mean to in
any way downplay the import of their their feelings on
the matter, but it's just the juxtaposition between what they
(27:14):
thought might be going on and what my actual upbringing
was was so completely at odds that it was a
little bit comedic to me. That's all so apologies. If
anybody was confused or dismayed by those comments, I'm telling
you you can be raised Catholic and still say their
own thing. If you would like to write to us
about today's episode or anything else that pops to your mind,
you can do so at History Podcast at how stuff
(27:35):
Works dot com. You can also connect with us at
mist in History, on Twitter, Facebook, dot com slash misst
in history at mist in history dot tumbler dot com,
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go if you want to get some cool missed in
History goodies like shirts and bags and phone cases. You
can also find us on pinterest dot com slash missed
in History. And if you would like to learn a
little bit more about what we talked about today, you
(27:57):
can go to our parents site how stuff Works in
the word sleep in the search bar, and you will
get an article called how sleep works and you will
learn a lot about how various things can happen to
you when you do and do not get enough sleep.
If you would like to visit us at our home
web page that's missed in History dot com, and you'll
find all of our episodes, show notes, the occasional blog
(28:17):
posts and cool are associated with all the episodes, uh
and we encourage you to do that and also visit
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Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.