Sleep Medicine

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Understand the dream, its processes and functions, is the backbone of Sleep Medicine, a branch, that brings together multidisciplinary contributions from such diverse medical specialities such as psychiatry, dentistry, pediatrics and otolaryngology. Sleep medicine encompasses all matters concerning human behavior during sleep in contrast to the typical treatment of the wakefulness.

Sleep Medicine is relatively young. As a formal discipline emerged in the early twentieth century, more specifically in the thirties, marked by a progressive technological development, that allowed a more objective approach to the study of sleep away from the first philosophical concepts. But the scientific interest in sleep is not exactly a novelty in medical history and the relationship between dreams and health has been recognized since antiquity. The early works date back to ancient Greece and Aristotle himself devoted to the phenomenon of sleep several pages written in Parva Naturalia historical treatise "sleep and wakefulness, "" In Dreams "and" Divination during sleep. " In the Roman temples erected in honor of Asclepius (the name the Romans gave to the Greek god Asclepius), exist the first known "chambers of sleep therapy".

Several authors have gathered, that these chambers were made to perform what included medical practices, from the interpretation of dreams through dream therapists for the evaluation of sleep quality as a tool for diagnosing diseases. The cult of Asclepius, in the context of priestly Greek medicine, is based on the "incubation", a process that consisted of a therapeutic-induced sleep in a room provided for that purpose. Patients dreamed, that Aesculapius appeared and expel evil, and when awakened, they were cured. Could we be referring to the first units of sleep?

Not until the late nineteenth century, when a quantum leap in human sleep was researched. The approach staged a substantial shift from 1875, Richard Caton discovered brain electrical activity, serving as proof, that the dream constitutes an active sleep neurological status, a claim, which had been discussed to date. The new studies changed radically outdated conception of sleep as a passive phenomenon without functional relevance and begins to shape our modern vision to understand sleep as an active and necessary process.

Technological advances applied to the investigation of sleep relaunch sleep medicine as a formal discipline from the thirties thanks to the application of new knowledge of electrical brain activity and the generalization of registrated techniques. In 1929, the psychiatrist and neurologist Hans Berger published the first research on records of oscillations in brain electrical activity by electroencephalogram (EEG). Berger noted, that the sleep EEG recordings gave quite different results than the records kept vigil. In these pioneer tests he found two types of well-defined and distinct waves, called alpha and beta rhythms. The rhythmic oscillations in brain activity reflect different neurophysiological states, that Berger showed in his first approximations. During rest or sleep were recorded predominantly alpha waves, while beta waves appeared more frequently during the vigil. Years later, the research completed the range of EEG recordings with theta and delta waves. Subsequently, in 1937, thanks to the findings of Loomis and his colleagues, the relationship between EEG change and the different stages of sleep were demonstrated, the four types of brain waves are related to the different states of consciousness. In1950, Aserinsky and Kleitman described the rapid eye movement (REM) and the division between "rapid eye movement" (REM) sleep and "non-rapid eye movement"sleep (NREM), thus completing in neurological organization of sleep.

Studies of electrical activity during sleep, led to the implementation of polysomnographic techniques. In such records, besides evaluating encephalographic and electrocardiographic activity, other factors as the eye- and chinmovements and breathing cycles. These records now the gold standard in sleep medicine for diagnosis and monitoring of patients with sleep disorders.

The health system has centers and units specialized in the treatment of sleep disorders in which the practice of polysomnographic recordings in bulk represents the actions of the specialists. These laboratories make up the current sleeping units that increase and spread rapidly in our health system.

The importance of sleep for health is not debatable today. Its therapeutic purposes are clear, and the comprehensive study of it, is the most important diagnostic tool. In 1989, Meir H. Kryger and colleagues published the first book on sleep medicine "The Principles and Practice of Sleep Medicine, defending Sleep Medicine as a specialty with complete rights. This growing interest in the medical community has led to the institutionalization of sleep medicine as multidisciplinary specialty, whose epicenter lay at the neurology but groups disparate disciplines such as pulmonology, dentistry, pediatrics or psychiatry. It is conceived as well as a global discipline, that regulates all matters concerning human behavior during sleep, its mechanisms, diseases and treatments.

The neuropsychology of sleep and the interactions between sleep and other body systems, such as respiratory or cardiovascular disease, have become the subject of constant investigation with inputs from different clinical disciplines, that have stimulated a spectacular growth of sleep medicine in the last fifty years. Many of these contributions come from the odontostomatology field. Sleep breathing disorders (SBD) are in what dentists have a great role. Currently, there are described 80 different sleep disorders and in some cases, such as sleep apnea and bruxism are directly related to dental practice. Because of its importance in the diagnosis and treatment of many of these disorders now the dental sleep medicine has become important, a branch of sleep medicine, that provides effective solutions of sleep disorders in many dental treatments such as of bruxism, apnea syndrome and chronic snoring, through the use of intraoral appliances.

The Academy of Dental Sleep Medicine (Academy of Dental Sleep Medicine, ADSM) world reference authority, supports the treatments with oral appliances to treat or alleviate obstructive sleep apnea and snoring, in their recommendations published by the American Academy of Medicine Sleep in the journal SLEEP.

But what is sleep? Do we know the ultimate goal of this phenomenon? We are not yet able to answer these questions, their ultimate role has not yet been clarified and their gear is still the subject of extensive research and studies of all kinds. Surprisingly, almost two thousand years after the first approaches, experts have not yet been able to establish with certainty the ultimate role, that the dream has theories and live together as disparate about their psychological and physiological function.