The Eternal Quest for a Good Night Sleep
This blog for Medical Museion explores historical concerns around sleep and sleep loss - in particular, how Victorian doctors and patients approached the problem of insomnia. It is part of a wider research project on the historical experience of circadian rhythms. You can find the original blog here.
While world has been gripped in the COVID-19 pandemic, sleep has also been making the headlines. Amid the confusion, uncertainty and sadness, people have also been struggling to sleep or sleeping too much. In particular, sleep researchers are fascinated with the phenomenon of intense ‘lockdown’ dreaming. The lockdown seems to have only intensified our obsession with our sleep and how to sleep better – if the proliferation of sleep tracking apps is anything to go by. And while all of this might seem very modern, people have actually been worrying about how to get a good night’s sleep for a very long time.
Recently, I was delighted to have been invited to speak to Radio Loud podcast Vi Er Data about my research into Victorian insomnia treatments. The team was interested to hear more about what people in the 19th century thought about sleep, what sorts of things they did to improve sleep and what they might make of our sleep apps today. To celebrate the podcast’s release, I wanted to go into a little more depth on some of the great topics we discussed and reflect on my own experiences of COVID-19 and sleep.
What did the Victorians think sleep was?
I love questions like this because they seem so simple and obvious, but the more you think about it, the more complicated it becomes. The fact is, there is still a lot we don’t know about sleep even today. While researchers have come a long way to understanding what happens during sleep, we still don’t really know the biological purpose of sleep or exactly what our dreams mean. So given that – I think we need to be forgiving to the Victorians for their ideas which can seem strange to us.
To put it very simply, in the second half of the nineteenth century, most (but not all) European scientists and physicians believed that sleep was caused by blood leaving your brain. Less blood in the brain meant the brain was less nourished, less responsive to stimuli, and therefore was ‘resting’. The theory of cerebral circulation was actually the opposite of what people had believed in the 18th century – with many people arguing that you needed to have plenty of blood in your brain to sleep. The change came about through new research in physiology – the scientific study of our bodily functions. British and American physiologists carried out experiments on vivisected animals which they believed showed how when sleep was induced, the brain became ‘bloodless’. This was corroborated by observations on human patients – particularly in people who had suffered from head injuries which had removed portions of their skull and allowed doctors to ‘watch’ the brain during sleep.
While not all doctors were convinced by the arguments of the physiologists – the connection between sleep and circulation was usefully ‘common sense’, and seemed to reinforce some of the longstanding remedies for sleeplessness. In particular, it chimed with much older ideas that the brain could be overstimulated or overheated – causing insomnia. However day to day, doctors didn’t worry too much about the technicalities of new research. In the main, they continued to recommend tried and tested remedies for sleeplessness that stretched back for centuries.
How important was sleep to people in the 19th century?
The Victorians thought sleeping well was absolutely essential to their health. In fact, we have thought this for a very very long time – at least as far back as the Ancient Greeks and Romans. Galen, the famous Greek philosopher and physician, included sleep as one of his ‘six non-natural things’: six ‘habits’ or practices humans had that were essential to staying alive. He counted ‘sleep’ among things like eating, bathing, exercising and breathing that our bodies couldn’t do without. In fact, you can’t really find a period of history where people didn’t think sleep was important – but arguably the Victorians were especially anxious about sleep. Much like today, the Victorians thought that ‘modern life’ was getting in the way of the kind of ideal sleep they imagined people had in the past. They looked back at agricultural times before the railroads, the telegraph and steam-power as an idyllic period were people were especially healthy and slept soundly. They found their world to be loud, busy and stressful – and while this negatively affected health in many ways, sleep was definitely a major concern. As one doctor wrote in the early twentieth century:
‘We are of little use without sleep: a civilization that can navigate air and send wireless messages incredible distances, however enlightened it may be, will not devise various means of excessive living and working successfully unless it includes in its scheme so many hours of complete rest to mind and body… Insomnia is now causing an appalling number of suicides and deaths through over-drugging; making the remainder of life a fell of agony for many thousands who are searching around in vain for help and finding none…’
This assessment of things seems a bit unfair though – in fact there were many many people willing to offer help to the sleepless, although whether it worked was another matter.
What were some common and some unusual sleep remedies?
Much of the sleep advice or ‘sleep hygiene’ that Victorian doctors recommended to their patients wouldn’t sound that out of place today – making sure you get exercise in the day, keeping your room dark and quiet, bringing a hot water bottle to bed with you, making sure you get to sleep the same time every night, not drinking too much tea or coffee. Something that is a bit different though is the emphasis that was placed on eating. Doctors thought that indigestion was the most common cause of insomnia – specifically, eating too much rich, heavy or spicy food too soon before bed. A recommended regimen would involve carefully considering what you ate throughout the day and when – making sure dinner was a few hours before bedtime. But they also thought that some foods could help you get to bed, and it was recommended to eat a small, nourishing snack right before bed – typically some beef tea, cocoa or perhaps some cooked chicken and lettuce.
Without a doubt though there were some weirder things people tried to get to sleep. A personal favourite of mine is the ‘faradic bath’ or the electric bath – in which the patient would lie in a tub of warm water which was electrified with a ‘mild’ current. The idea was that the electricity would stimulate your nerves and strengthen your nerve ‘tone’ – helping you to withstand stress and sleep better at night. Some people reported that this cure was very helpful, but others suggested it was simply having a warm bath before bed that was helping with sleep. Of course, electricity and water do not mix – and this cure was highly dangerous! Then again, I have not found any examples of people being killed by an electric bath – and many many people died as the result of addictive drugs used to treat insomnia.
What do you think people in the future will think about sleep-apps and sleep-trackers?
In each period of history, we always think we are exceptional. The Victorians thought they were exceptionally tired and overworked – their lives were more overwhelming and hard than anyone who came before them. I think we tend to think this about ourselves too – and that sleep apps are just a part of this anxiety. While they might seem like something new and exciting, I think people in the future will look at sleep-apps as just another thing in a long line of attempts to sleep better.
I do think though that the sleep apps themselves will be an interesting historical resource on how well we are in fact sleeping! One of the difficulties with studying sleep in the 19th century is that all of the information is self reported – and we know that people tend to think they sleep worse than they actually are. Even people who claim they hardly slept at all, might later find that they got a few hours. Victorian doctors were aware of this, but it was hard for them to prove it without directly observing their patient. I suspect that sleep tracking apps will show that we sleep now the way that people have slept in the past – for about 7 hours a night. And I seriously doubt in the future people will have found a way to get around sleeping!
COVID-19 and studying sleep
During the interview, I was asked whether I as a someone who studies sleep ever struggle to sleep. I was a bit taken aback by the question and answered that luckily I didn’t have problems sleeping. But this isn’t strictly true – or certainly hasn’t been the case during the lockdown. For many of us, sleep is something that happens everyday and we don’t think about it very much until there is a problem. When you woke up this morning, did you reflect on how odd it was that you lost consciousness for about 8 hours last night? Probably not. But for the first few weeks of the lockdown, I was keenly aware that my sleep patterns were being disrupted. I was sleeping a lot – going to bed by about 9.30pm and not waking up until 9am. And despite this marathon of sleeping – I was never rested, which I was always constantly aware of, because of a very annoying twitching eye. And like many other people, I was also having very intense dreams.
But I actually also kept in mind what my Victorian doctors would say to me – if I asked them about my problems sleeping. And the main thing I thought about was regularity and habit. The best cure for not sleeping or not sleeping well is to simply keep trying – to go to bed at the same time every day, make sure that the room is dark, calm and quiet, and try not to worry about things too much. Insomnia is self-reinforcing – the more you think about how you can’t sleep the less you can sleep. Doctors observed this phenomenon in their patients, and always advised them to think positively, to tell themselves they would get a good night sleep and not worry too much if one night they didn’t. One cultural historian of sleep has described it as ‘performance art’. We all do the same things each night to ‘perform’ sleep – we put on pajamas, lock up the house, use the restroom, have a glass of water, get comfy, and close our eyes. We play act at sleeping before sleep comes. Next time you can’t fall asleep, maybe try thinking of it this way!