Licking skulls and selling sleep: a (very brief) history on the treatment of disordered sleep

Everything we know about sleep we have discovered in the last 50 years. It is a statement we have read time and time again. However sleep disorders have been around a lot longer and, together with a lack of scientific knowledge, have resulted in some pretty strange theories and treatments.

The ancient world was riddled with them. Sleep disorders such as narcolepsy and parasomnias were often explained by supernatural spirits. Previous ‘Strange but True’ articles have elaborated on the night hag creature that was believed to cause sleep paralysis. The Babylonians believed bruxism was a deceased family member trying to communicate.1,2 The cure – sleep with a human skull for seven days, but not before kissing and licking it seven times each night.

Unfortunately for this article, the causal agents behind snore were fairly accurate and insomnia was hard to define. The ancient Greek and Romans knew over-eating, drinking and supine sleep promoted snore3,4 and sleeplessness was a typical occurrence in the ancient world.5

As the quality of life improved through socioeconomic and technological gains, humans became progressively controlled by time: time to wake, time to work and time to sleep. As such, sleep became a valuable and sellable commodity and during the industrial age, unregulated medicinal products claiming to treat sleeplessness flooded the market.

It probably comes as no surprise that opiate based products were a very popular choice for promoting sleep. One such example was Chlorodyne: a miracle treatment for many ailments such as stomach upsets, migraines and insomnia.6,7 What made it so miraculous? A mixture of laudanum (opiates in an alcohol solution), chloroform and cannabis. There is no doubt it worked, but it was also very addictive and sometimes fatal.

chlorodyne

Advertisement for J Collis Browne’s Chlorodyne, 1891 (from Ward &Lock’s ‘Illustrated Guide to Glasgow and the Clyde’)

 

There were also opiates for babies, with products such as Godfrey’s Cordial and Mother’s Friend promoting relief from crying, teething and sleeplessness.8,9 The popular American tonic Mrs Winslows Soothing Syrup sold 1.5 million vials annually.10 The key ingredient: 65mg morphine/ounce.

The older children didn’t miss out either. They had access to a selection of yummy pastilles laced with narcotics available for their purchase.11

jars

Rows of jars for pastilles with various ingredients, including one for 'Liquorice & Chlorodyne', on display in the Gibson & Son Pharmacy at the Science Museum, Lower Wellcome Gallery.

 

Unfortunately these products were so successful at sedating a child, they were quickly used to quieten hungry infants or to ease the load on nurses, thus earning the nickname ‘poor child’s nurse’.9,11,12 So when these children died of an overdose, they were so malnourished, starvation was often documented as the cause of death.

soothing syrup

Advertisement for Mrs Winslow’s Soothing Syrup from 1885   Courtesy of the US National Library of Medicine, produced by Meyer, Merkell & Ottmann in New York.

 

Today, pharmaceutical products containing known dangerous ingredients are tightly regulated, and often require a prescription. However in every pharmacy there are aisles dedicated to natural remedies and supplements promising relief from all sorts of ailments, despite a lack of scientific evidence (or even the presence of a disclaimer on the bottle). So instead of sedating people with morphine, they are being swayed by the placebo effect. Instead of seeking professional help, people believe their sleepiness is a byproduct of lifestyle, and therefore disregard snoring, moving and gasping because there is a supplement that has been advertised to help them. This placebo effect may be excellent for some types of insomnia, but not for those with underlying OSA or movement disorders.

As for the internet – well that is a great source of modern day ‘quackery’. The Orbit Bio Anti Snore Pendant can stop snore in 2-4 weeks with one easy payment of NZ$109.90.13 How you ask? Well to be honest, it was hard to really make sense of the claim so we have just added it below:

“Manufactured by the laboratory “Biophotone GmbH” (Germany) according to the latest discoveries of quantum physics, Orbit Bio Pend Anti Snore of is charged with the frequency  of oxygen, precious stones, semiprecious stones and Suman resonance which are very beneficial for your health and transform themselves into a ‘vital force’ that can relieve snoring and aid good sleep.”

 In the past the anti-snore pressure rings were also a very popular item (until the Australian Competition and Consumer Commission stepped in14) and insomnia can be a thing of the past with the pyramid energy balance by eliminating electromagnetic fields within an 18 metre radius.15 The latter was a favourite not because of the lack of scientific evidence, but because it lists several modern day, EMF emitting, devices we should avoid but then tries to sell you an e-book, which you must buy over the internet.

And sleep apnoea can be treated with a simple herbal remedy16

“Put that CPAP machine in the closet. Sleep Naturally with herbal relief. Sleep well tonight, free of straps and tubes.”

    - Nature’s Rite Sleep Apnea Relief tablets

Thankfully, below all the ‘evidence’, at the bottom of the page, in extremely small print, they do say: These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

However, putting the strange internet remedies aside, we should also be cautious when implementing current treatments for sleep complaints. Many adult patients who could be diagnosed with OSA within 10 seconds of seeing a respiratory physician, are going to their GP and being put on muscle relaxants to aid sleep (which almost feels like throwing water on a drowning person); there was the ASV recall due an increased risk of mortality in specific populations17; and our current medications for narcolepsy include modafonil – a drug whose mode of action is unknown18, dexamphetamines – a known addictive stimulate, and in the USA, Gamma hydroxybutyrate (GHB)– a known central nervous depressant. Even CPAP, the gold standard for OSA treatment, is only 35 years old; we can’t possibly know if there are any long term side effects from splinting open the airway.

Then if we look at paediatric patients, adenotonsillectomy is one of the main treatments for snoring and upper airway resistance (UAR). A treatment that not only puts the child at a greater potential risk but may have limited success. Several studies have shown children with the milder forms of UAR that are treated with adenotonsillectomy, may stop snoring but retain other problematic deficits such as cardiovascular abnormalities and autonomic arousal issues. There are also questions being raised about the natural history of childhood snoring and infant sleep disordered breathing, and whether such ‘disorders’ are a common and normal part of growth and development (thus circumventing the need for surgical interventions).19 Who knows – tonsillectomy for mild UAR may be deemed as unnecessary and barbaric as blood-letting was for headaches and transorbital lobotomies were for defiant children.

Overall, we have come an exceptionally long way from licking skulls, but sleep science is still adolescent. In 50 years from now our current treatments may be met with raised eyebrows or even be deemed as barbaric but it is our job as sleep experts to raise those eyebrows by progressing the knowledge of sleep science and developing new gold standards in treatment.

Melissa Cava and Scott Coussens

REFERENCES

1.       Belofsky N. Strange Medicine: A Shocking History of Real Medical Practices through the Ages. Perigee Books; 2013

2.      http://www.history.com/news/history-lists/7-unusual-ancient-medical-techniques

3.       Pirsig W. Snoring in the ancient world. Sleep and Breathing. 2002; 6(1): 29-39.

4.       Netzer NC. Sleep Medicine before and after Dickens. Sleep and Breathing. 2002;6(1): 41-43.

5.       Summers-Bremner E. Insomnia .London: Reaktion; 2010

6.       Conlon M F. Addiction to chlorodyne. British medical journal. 1963; 2(5366): 1177.

7.       Parker R R., Cobb J P. & Connell P H. Chlorodyne dependence. BMJ. 1974; 1(5905):427-429.

8.       T. E. C. Jr. What were Godfrey's Cordial and Dalby's Carminative? Pediatrics. 1970; 45(60: 1011

9.       Jordan TE. The keys of paradise: Godfrey's cordial and children in Victorian Britain. The Journal of the Royal Society for the Promotion of Health. 1987; 107(1): 19-22.

10.   http://www.woodlibrarymuseum.org/museum/item/529/mrs.-winslow's-soothing-syrup

11.   http://blog.sciencemuseum.org.uk/collections/2012/04/25/the-addictive-history-of-medicine-opium-the-poor-childs-nurse/

12.   http://www.harpweek.com/09Cartoon/RelatedCartoon.asp?Month=January&Date=29

13.   http://www.orbithealth.co.nz/product/orbit-bio-anti-snore-pend/

14.   https://www.accc.gov.au/media-release/anti-snoring-ring-found-wanting

15.   http://www.lifeenergysolutions.com/pe-bal/

16.   http://www.mynaturesrite.com/sleep-apnea.php

17.  https://www.tga.gov.au/alert/resmed-devices-use-adaptive-servo-ventilation-therapy

18.   Gerrard P. & Malcolm R. Mechanisms of modafinil: a review of current research. Neuropsychiatric disease and treatment 2007;3(3): 349.

19.   Redline S., Amin R., Beebe D., Chervin R. D., Garetz S. L., Giordani B., ... & Ellenberg, S. The Childhood Adenotonsillectomy Trial (CHAT): rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population. Sleep. 2011;34(11): 1509.