The document summarizes historical perspectives on sleep from ancient cultures like Greece, China, and India. It then discusses views of sleep in various religions such as Christianity, Buddhism, Islam, Hinduism, and Judaism. Finally, it outlines current scientific concepts of sleep including sleep architecture, the sleep cycle, and different sleep stages.

1. Santa Fe, New Mexico
July 29- August 2, 2013

2. Sleep: An analysis of
this entity and its
influence on the
development of
mankind in areas of
religion, medicine, scien
ce, arts, and literature

3. Sleep and Yesterday?
Dream and Yesterday?
(Show of hands)

4. “Yesterday” - Sir Paul
McCartney
http://www.youtube.com/watch?v=Ms65JQT
BCcQ

5. Dr. Indal M. Seudeal
Areas of practice
Internal medicine
Pulmonary medicine
Critical care medicine
Emergency room medicine
Sleep medicine
ABIM Board certified sleep specialist

6. Outline
Historical perspective of Parasomnias
sleep REM behavior disorder
Night terrors/nightmares
Sleep and religious views
Catathenia
Christianity
Sleepwalking
Buddhism
Sleep swimming
Islam
Sudden unexplained
Hinduism nocturnal death syndrome
Judaism Sleep sex
Sleep crimes
Current concepts
Narcolepsy
Architecture of sleep
States of sleep Brilliant dreams

7. Historical Perspectives
of Sleep

8. 800-600 B.C., Homer’s
Odyssey
Epic Greek poem
“In his first sleep, call up
your hardiest cheer.”
Segmented sleep
2 shifts awake/2 shifts sleep
per 24 hours
http://healthysleep.med.harvard.edu/healthy/
matters/history

9. 350 B.C., Aristotle
“Sleep is…a seizure of the
primary sense organ…”
Seat of consciousness:
heart
Sleep onset – warm gastric
vapors (digestion)
http://healthysleep.med.harvard.edu/healthy/
matters/history

10. ~1490, Leonardo da
Vinci
Polyphasic sleep: daVinci
sleep (15 mins./2 hours)
Anatomical paintings
explain complexity of
human nervous system
http://healthysleep.med.harvard.edu/healthy/
matters/history

11. 1598, William
Shakespeare
Henry IV (1598): obstructive sleep
apnea, Cheyne-Stokes respiration
Hamlet: “To be, or not to be, that is the
question: Whether 'tis nobler in the
mind to suffer The slings and arrows of
outrageous fortune, Or to take arms
against a sea of troubles And by
opposing end them. To die—to
sleep, No more; and by a sleep to say
we end The heart-ache and the
thousand natural shocks That flesh is
heir to: 'tis a consummation Devoutly
to be wish'd. To die, to sleep; To
sleep, perchance to dream—ay, there's
the rub: For in that sleep of death what
dreams may come, When we have
shuffled off this mortal coil, Must give
us pause—there's the respect That
makes calamity of so long life.”
http://healthysleep.med.harvard.edu/healthy/
matters/history

12. 1737-1798, Luigi Galvani
Italian physician
Discovers natural electrical
activity in nervous system
and muscles
This discovery led to
measurement of brain
activity during sleep
http://healthysleep.med.harvard.edu/healthy/
matters/history

13. 1769-1821, Napoleon
Bonaparte
Sleep prescription
Sleep habits: possible
obstructive sleep apnea
http://healthysleep.med.harvard.edu/healthy/
matters/history

14. 1903, First sleeping pill
Barbital (Veronal)
German chemists Emil
Fischer and Joseph von
Mering
http://healthysleep.med.harvard.edu/healthy/
matters/history

15. 1916, The hypothalamus
and sleep
Constantin von Economo
studied patients with viral
encephalitis
Discovered sleep and wake
regions of the brain
(hypothalamus)
http://healthysleep.med.harvard.edu/healthy/
matters/history

16. 1935, Biological clock
German biologist Erwin
Bunning describes the
biological clock
Worked with common
green bean plants
Conclusion: circadian
rhythms are inherited
http://healthysleep.med.harvard.edu/healthy/
matters/history

17. 1953, Discovery of REM
sleep
http://healthysleep.med.harvard.edu/healthy/
matters/history

18. http://healthysleep.med.harvard.edu/healthy/
matters/history

19. 1997, Mammalian clock
genes
Joseph Takahashi
(Northwestern University)
Identify and clone
mammalian circadian gene
(Clock gene)
http://healthysleep.med.harvard.edu/healthy/
matters/history

20. 2003, Sleep and
memory
Sleep: important role in
learning and memory
consolidation
http://healthysleep.med.harvard.edu/healthy/
matters/history

21. “Yesterday” - Sir Paul
McCartney
http://www.youtube.com/watch?v=Ms65JQT
BCcQ

22. Sleep and Religious
Views
Christianity
Buddhism
Islam
Hinduism
Judaism

23. Christianity
The term sleep is used symbolically in different senses in
the Bible
• To stress certain truths about God
• “He will not allow your foot to slip; he who keeps you will
not slumber. Behold, he who keeps Israel will neither
slumber nor sleep” (Psalms 121:3-4)
• Sometimes sleep is used as the equivalent of being lazy
• “Do not give sleep to your eyes, nor slumber to your
eyelids… How long will you like down, O sluggard? When
will you arise from your sleep? A little sleep, a little slumber,
a little folding of the hands to rest. And your poverty will
come in like a vagabond, and your need like an armed
man.” (Proverbs 6:4-11)
Christian Courier Publications. ISSN 1559:2235

24. Christianity
• To portray the utter and final punishment of a wicked power
• Prophet Jeremiah foretold the complete destruction of the
evil Babylonian regime:
• “… Babylon shall become heaps, a dwelling-place for jackals, an
astonishment, and a hissing, without inhabitant… When they
are heated, I will make their feast, and I will make them
drunken, that they may rejoice, and sleep a perpetual sleep, and
not wake, saith Jehovah” (Jeremiah 51: 37-39)
• Sometimes spiritual lethargy is represented as sleep
• Paul wrote:
• “And this, knowing the season, that already it is time for you to
awake out of sleep: for now is salvation nearer to us than when
we first believed” (Romans 13:11)
• “Awake, you who are sleeping, and arise from the dead, and
Christ shall shine on you” (Ephesians 5:14)
Christian Courier Publications. ISSN 1559:2235

25. Christianity
• Sleep can suggest the notion of being unprepared to
meet the Lord
• Jesus warned:
• “Watch therefore: for you do not know when the lord of
the house is coming…lest he come suddenly and find
you sleeping” (Mark 13:35-56)
• Commonly used as a designation for death in both Old
and New Testement
• David petitioned the Creator:
• “Consider and answer me, O Jehovah my God: Lighten
my eyes, lest I sleep the sleep of death” (Psalms 13:3)
Christian Courier Publications. ISSN 1559:2235

26. Christianity
• Sometimes sleep implies the future resurrection of the
human body
• “But now Christ is risen from the dead, and has become the
firstfruits of those who have fallen asleep.” (1 Corinthians
15:30)
Christian Courier Publications. ISSN 1559:2235

27. Buddhism
Buddha Gautama
Insight into cause of
suffering and steps
necessary to eliminate it
Sat under the bodhi tree,
where he vowed never to
arise until he found the
truth
49 days of meditation at
age 35
Attained enlightenment
Bodhi tree

28. Buddhism
Dalai Lama: “Sleep is the best meditation” (People Magazine, 1979)
AH: So you go to bed at 8:30 at night and you wake up at 3:30. You clearly put a lot of
emphasis on sleep, which we love, because at The Huffington Post we have dedicated
sections on sleep. So what’s the secret of sound sleep, and why is it so important?
HHDL: For me, very important. The other day, in Delhi, of course my car always
provided by government. This one driver, one new driver come, then I ask him, “How
many hours you sleep?” He says, “Four hours.” Then I told him, “Four hours not
adequate. So you must sleep six hours.” Then next day, I met, “How many hours?”
Then he told me, “Six hours.” So I believe, you see, sleep, complete restful, and also I
think important is daytime your mind calm, relaxed. Then dream, during night, it’s
sleep, also then, happy dream. Too much anxiety in daytime, then even in dream, some
kind of nightmare, or these things happen. So, and anyway, for me, sleep, sound sleep
usually eight hours, sometimes, last night, nine hours. Very sound sleep. And then
also, when I handed over all my political responsibility to a … person, political
leadership, formally, that night, very unusual sound sleep.

29. Buddhism

30. Islam
Islam
Emerged as a religion in the 7th century
2 sources of Islamic jurisprudence (the Quran and
Hadith)
Allah revealed the Quran to the prophet Muhammad
through the angel Gabriel from 610-632 C.E. (verse
17.106)

31. Islam
Types of sleep:
1. Sinah: slumber or dozing off for a very short period
• “No slumber (Sinah) can seize Him nor sleep” (verse 2.255)
• May correspond to stage 1 sleep
2. Nu’ass: short nap
• “Remember when He covered you with a slumber (Nu’ass)
as a security from him” (verse 8.11)
• May correspond to stage 1/stage 2 sleep
3. Ruqood: sleep for long period
• “And you would have thought them awake, whereas they
were asleep (Ruqood) (verse 18.18)

32. Islam
Types of sleep:
4. Hojoo: sleep at night
• “They used to sleep but little by night (Hojoo). And in the
hours before dawn, they were (found) asking (Allah) for
forgiveness” (verse 51. 17-18)
5. Subaat: disconnection from the surrounding
environment during sleep
• “And we made your sleep (Subaat) as the thing for rest”
(verse 78.9)

33. Islam
Prophet Muhammad
Encouraged not to be involved in any activity after Isha
prayer (darkness prayer)
“One should not sleep before night prayer, nor have
discussions after it” (SB 574)
Encouraged to wake up for Fajr prayer (which is about 1
hour before sunrise)
Sleep on the right side and avoid lying on the stomach
“Whenever you go to bed, perform ablution like that for the
prayer, and lie on your right side” (SM 2710)
The Prophet told a man who was lying on his stomach,
“Allah and his Prophet dislike this position”

34. Islam
The Quran indicates some resemblance between sleep and
death
The Quran uses Wafat to describe death
“It is Allah Who takes away the souls (Wafat) at the time of
their death, and those that die not during their sleep. He keeps
those (souls) for which He has ordained death and sends the
rest for a term appointed. Verily, in this are signs for people
who think deeply” (verse 39.42)
“It is He Who takes your souls (Wafat) by night (when you are
sleep), and has knowledge of all that you have done by
day, then He raises (wakes) you up again that a term appointed
(your life period) be fulfilled, then (in the end) to Him will be
your return. Then He will inform you of that which you used to
do” (verse 6.60)

35. Hinduism
Hindu architecture: Vaastu Shastra
The world is a manifestation of the body of God:
more precisely, the world IS the body of God
A temple compared to the large universe is a
constructed miniature version (microcosm) of the
greater universe (macrocosm)

36. Hinduism
Alignment of energies
The head of the bed is directed towards south, east, or west, but
never north
A person’s body is a tiny magnet (with north and south poles)
One’s head is the north pole
The universe is also a magnet with north and south poles (polaris
the north star is the north pole of the universe)
2 like poles will repel each other
Conclusion: sleep will be better when the head is placed away from
the north

37. Judaism
Judaism views the gift of sleep as a Godly blessing
Maimonides, the great doctor, lists in his halachic
work, Mishna Torah, his recommendation for 8 hours
of sleep per night
Shabat was given the blessing of being the day of
rest and leisure
Sleeping on Shabat afternoon has become a time-
honored Jewish custom

38. Judaism: Analysis of sleep in the context of
Judaism by Rabbi Nissan D. Dubov (Director of
Chabad Lubavitch in Wimbledon, UK)
Sleep is good for digestion
Soul searching prior to sleep / “let go of baggage
before sleep onset” / recite prayer
Your body belongs to God and is given to you as a
deposit
Pray at time of awakening
While sleeping, soul is elevated to an upper level of
consciousness and draws life from the higher world

39. Judaism: Analysis of sleep in the context of
Judaism by Rabbi Nissan D. Dubov (Director of
Chabad Lubavitch in Wimbledon, UK)
0:09:30-0:11:20
Soul searching prior to sleep / “let go of baggage
before sleep onset” / recite prayer

40. Judaism: Analysis of sleep in the context of
Judaism by Rabbi Nissan D. Dubov (Director of
Chabad Lubavitch in Wimbledon, UK)
28:30-29:45
Pray at time of awakening*

41. Judaism: Analysis of sleep in the context of
Judaism by Rabbi Nissan D. Dubov (Director of
Chabad Lubavitch in Wimbledon, UK)
51:10-51:36
While sleeping, soul is elevated to an upper level of
consciousness and draws life from the higher world

42. “Yesterday” - Sir Paul
McCartney
http://www.youtube.com/watch?v=Ms65JQT
BCcQ

43. Current Concepts of
Sleep

44. Current Concepts of
Sleep: Sleep stages
4-5 cycles/night
Stage
1 Every 90-110 minutes
Stage 3: slow wave
Stage sleep (SWS)
REM
2 REM: rapid eye
movement sleep
(predominant in last
Stage 1/3 of sleep time)
3

45. Current Concepts of
Sleep: Sleep
Architecture
25% 5%
Stage 1 5% sleep
45% Stage 2 45% sleep
Stage 3 20% sleep
REM
20%

46. Current Concepts of
Sleep
Stage 1
Light sleep
Slowing of heart rate and
respiration
Brain waves: slowing of
brain activity
Decreased muscle tonus

47. Current Concepts of
Sleep
Stage 2
Slower brain activity
Further decrease in heart
rate and respiration
Further decrease in muscle
tonus

48. Current Concepts of
Sleep
Stage 3
Slow wave sleep
Change in brain waves to
large slow delta waves
Continued decrease in
heart rate and respiration
Continued decrease in
muscle tonus

49. Current Concepts of
Sleep
Stage REM
Rapid eye movement sleep
Brain waves are similar to that of awake
Large fluctuations in heart rate and respiration
Almost complete paralysis

50. Current Concepts of
Sleep
Take home pearls
1. 3 STATES OF EXISTENCE
a) Wake
b) Non REM sleep (stages 1, 2, and 3)
c) REM sleep
2. REM SLEEP IS SIMILAR
PHYSIOLOGICALLY TO THE WAKE STATE

51. Parasomnias

52. Parasomnias
A category of sleep disorders that involve abnormal
and unnatural
movements, behaviors, emotions, perception, and
dreams that occur while falling
asleep, sleeping, between sleep stages, or during
arousal from sleep

53. Parasomnia: REM
Behavior Disorder
The normal loss of muscle tone during sleep is absent
in REM behavior disorder
The patient is able to act out his/her dreams with
movements, vocalizations, etc.
Can be very disturbing to the patient and family
members
Can lead to serious physical injury to self and others

54. Parasomnia: REM
Behavior Disorder
http://www.youtube.com/watch?v=z2BgjH_Ct
IA

55. Parasomnia: REM
Behavior Disorder
http://www.youtube.com/watch?v=IEgvw1Z-
0co

56. Parasomnia: REM
Behavior Disorder
http://www.youtube.com/watch?v=rFXYRQ9x
PUA

57. Parasomnia: REM
Behavior Disorder
http://www.youtube.com/watch?v=rFXYRQ9x
PUA

58. Parasomnia: Night
terrors/nightmares
Arise from stage 3 sleep and REM sleep
http://www.youtube.com/watch?v=UQXJWzLj
zLk

59. Parasomnia:
Catathrenia
Loud annoying sleep groan
http://www.youtube.com/watch?v=9aT8vll4f
BE

60. Parasomnia:
Sleepwalking
http://www.youtube.com/watch?v=mlQRiGSy
1o4

61. Parasomnia: Sleep
swimming

62. Parasomnia: Sleep
swimming
http://bodyodd.nbcnews.com/_news/2012/08/
28/13511255-swimming-in-her-sleep-how-the-
idaho-woman-did-it?lite

63. Parasomnia: Sudden unexplained
nocturnal death syndrome
Affects primarily young Hmong men from Laos
(median age 33) and northeastern Thailand (where
the population are mainly of Laotian descent)
Brugada syndrome
Mutation of SCN5A on chromosome 3p21
Characterized by ventricular fibrillation and death
during sleep

64. Parasomnia: Sudden unexplained
nocturnal death syndrome
http://www.youtube.com/watch?v=eNAG4PG
Kj0c

65. Parasomnia: Sleep sex
(sexsomnia)
An NREM parasomnia
Engage in sexual activity while sleeping (have no memory of actions once
awake)
Cause: unknown (may be a genetic component)
Males account for 2/3 of cases
Effects:
Anger
Confusion
Denial
Fear
Treatment: combination of medication, therapy, and lifestyle changes

66. Sleep Crime
Crimes committed in sleep including homicidal somnambulism
Steven Steinberg case:
1981, Scottsdale, AZ: murdered wife by stabbing her 26 times
Claimed crime committed during sleepwalking
He walked away a free man
Kenneth Parks case:
1987, Toronto, Canada:
Drove 23 km to mother-in-law’s home and stabbed her to death
Drove to police station to report crime
Verdict: not guilty
“Can sleepwalking be a murder
defense?”, Lawrence
Martin, M.D., FACP, FCCP

67. Sleep Crime
Scott Falater case:
1997, Phoenix, AZ: murdered wife by stabbing her 44 times
and holding her head under water in the swimming pool
Claimed he was sleepwalking at the time of the murder
Verdict: guilty of First Degree Murder; life imprisonment
without parole
Burgess case:
1996, Queensland, Australia: hit woman on the head with a
bottle and tried to strangle her
Claimed sleepwalking
Verdict: not guilty
“Can sleepwalking be a murder defense?”,
Lawrence Martin, M.D., FACP, FCCP

68. Parasomnia: Narcolepsy
Intrusion of sleep state into wake state
Tetrad:
Excessive daytime sleepiness
Sleep paralysis
Hallucinations
At sleep onset (hypnogogic)
At sleep offset (hypnopompic)
Cataplexy

69. Parasomnia: Narcolepsy
http://www.youtube.com/watch?v=59evkMq_
QcM

70. Parasomnia: Narcolepsy
http://www.youtube.com/watch?v=HOkckq9p
foE

71. “Yesterday” - Sir Paul
McCartney
http://www.youtube.com/watch?v=Ms65JQT
BCcQ

72. Brilliant Dreams

73. Mary Shelley's Frankenstein
Inspired By a Dream
1816, Lake Geneva, Switzerland at Lord Byron’s villa
Stormy weather, retired indoors, went to bed.
“On the morrow I announced that I had thought of a
story. I began that day with the words, ‘It was on a
dreary night of November’”

74. Dream leads to Nobel
Prize
Otto Loewi (1873-1961), German physiologist
Nobel prize (medicine, 1936): work on chemical
transmission of nerve impulse
Came up with the idea of chemical transmission, 1903
17 years later, dreamt again of chemical transmission
“I got up immediately, went to the laboratory, and
performed a single experiment on a frog’s heart
according to the nocturnal design.”

75. Abraham Lincoln dreamt
of his own assassination
President Abraham Lincoln recounted
the following dream just a few days
prior to his assassination:
“About ten days ago, I retired very late.
…I soon began to dream. There
seemed to be a death-like stillness
about me. Then I heard subdued sobs.
…”
“I thought I left my bed and wondered
downstairs. … I went from room to
room: no living person was in sight, …
I arrived at the East Room”

76. Abraham Lincoln dreamt
of his own assassination
“Before me was a catafalque, on
which rested a corpse wrapped in
funeral vestments”
“’Who is dead in the White House’? I
demanded of one of the soldiers ‘The
President’ was his answer; ‘he was
killed by an assassin!’ Then came a
loud burst of grief from the
crowd, which awoke me from my
dream”

77. Kekulé dreams of molecules
and benzene structure
Friedrich August Kekulé von Stradonitz
Discovered tetravalent nature of carbon and the
Structural Theory
“I fell into a reverie, and lo, the atoms were gamboling
before my eyes!”
“I had never been able to discern the nature of their
motion.”
“I saw how, frequently, two smaller atoms united to form
a pair; how a larger one embraced the two smaller ones”
“The cry of the conductor: ‘Clapham Road’, awakened me
from my dreaming”

78. Kekulé dreams of molecules
and benzene structure
Another dream helped him discover the
benzene molecule (circular structure)
“I was sitting on my textbook… I turned my
chair to the fire and dozed.”
“Again the atoms were gamboling before my
eyes.”
“long rows of atoms sometimes more closely
fitted together all twining and twisting in
snake-like motion. … One of the snakes had
seized hold of its own tail, and the form
whirled mockingly before my eyes.”

79. Madame C.J. Walker – From
Dream to Millionaire
Madame C.J. Walker (1867-1919), first female
American self-made millionaire
Founded successful African-American cosmetic
company
Suffered from scalp infection (caused her to lose
most of her hair in 1890s)
Dreamt “A big black man appeared to me and told
me what to mix up in my hair. Some of the remedy
was grown in Africa, but I sent for it, mixed it, put it
on my scalp, and in a few weeks my hair was coming
in faster than it had ever fallen out.”

80. The Sewing Machine
Elias Howe, 1845
Had idea of a machine with a needle which would
go through a piece of cloth: couldn’t figure out
exactly how it would work
His dream: he was taken prisoner by a group of
natives; they were dancing around him with
spears.
As he saw them move around him, he noticed that
their spears all had holes near their tips
By locating a hole at the tip of the needle, the
thread could be caught after it went through cloth
thus making his machine operable

81. Jack Nicklaus Finds a New
Golf Swing in a Dream
Jack Nicklaus, 1964: having a bad slump
(high 70s)
“Wednesday night I had a dream and it was
about my golf swing.”
“I was hitting them pretty good in the
dream and realized I wasn’t holding the club
the way I’ve been holding it lately”
“So when I came to the course yesterday
morning I tried it the way I did in my dream
and it worked. I shot a sixty-eight yesterday
and a sixty-five today.”

82. Srinivasa Ramanujan –
Mathematical Genius and
Dreamer
Inspiration and insight for his work many times came
to him in his dreams
Hindu goddess, Namakkal, would appear and present
mathematical formulae which he would verify after
waking

83. Dreams and the King of
Horror
Novelist Stephen King describes how dreams affect his writings in an interview with UK
reporter Stan Nicholls:
Nicholls: "If the inspiration for Misery didn't come from a real-life incident, where did it
come from?"
King: "Like the ideas for some of my other novels, that came to me in a dream. In fact, it
happened when I was on Concord, flying over here, to Brown's. I fell asleep on the
plane, and dreamt about a woman who held a writer prisoner and killed him, skinned
him, fed the remains to her pig and bound his novel in human skin. His skin, the writer's skin.
I said to myself, 'I have to write this story.' Of course, the plot changed quite a bit in the
telling. But I wrote the first forty or fifty pages right on the landing here, between the ground
floor and the first floor of the hotel."
"Another time, when I got road-blocked in my novel It, I had a dream about leeches inside
discarded refrigerators. I immediately woke up and thought, 'That is where this is supposed
to go.' Dreams are just another part of life. To me, it's like seeing something on the street you
can use in your fiction. You take it and plug it right in. Writers are scavengers by nature."
Nicholls comments: "This could explain the line in Bag of Bones that goes, Perhaps in dreams
everyone is a novelist."

84. Paul McCartney finds
“Yesterday” in a dream
1965 filming Help!, McCartney staying in a small
attic room of his family’s house on Wimpole
Street
Dream: “I woke up with a lovely tune in my head.
I thought, 'That's great, I wonder what that is?'
There was an upright piano next to me, to the
right of the bed by the window. I got out of bed,
sat at the piano, found G, found F sharp minor
7th -- and that leads you through then to B to E
minor, and finally back to E. It all leads forward
logically. I liked the melody a lot, but because I'd
dreamed it, I couldn't believe I'd written it. I
thought, 'No, I've never written anything like this
before.' But I had the tune, which was the most
magic thing!"

85. “Yesterday” - Sir Paul
McCartney
http://www.youtube.com/watch?v=Ms65JQT
BCcQ

86. Conclusions Evolutio
n
Living Beings
Sleep
CONCEPTS:
Early / Religious / Scientific
What ifs???
• Unihemispheric sleep (dolphins and seals, Canadian geese)
• Plants (Mimosa pudica)
• Mark 14:32-42

87. Conclusions
Final thoughts
Sleep: one third of your existence
“Make it worth it!”
http://www.youtube.com/watch?v=uNkaeUr3
-HU