Sleep Cure: what it is, how it was used, and why it is no longer recommended.

Summary of how the sleep cure is performed, and why it is no longer recommended as a treatment.

Getting a good night's sleep is essential for a healthy life. For this reason it is not surprising that when psychological problems appear, such as stress, depression or serious psychiatric disorders, people have trouble falling asleep.

Since the birth of psychology and psychiatry it has been considered that a good way to help the person to recover his mental stability is, precisely, to make him sleep.

The sleep cure is a treatment that has been applied in people with diverse psychopathology, not being exempt of controversy.. Next we will see more in depth this practice, called "intensive therapy" in the psychiatric field.

What is the sleep cure?

In psychiatry, a sleep cure is the procedure by which the patient is induced to sleep for a long period of time, several days. the patient is induced to sleep for a long period of time, of several days, being normally between 6 to 7 days, although there have been cases up to 3 weeks.usually between 6 to 7 days, although there have been cases of up to 3 weeks.

In order to get the person to sleep for such a long period of time various types of psychopharmaceuticals are administered, in particular hypnoticsspecifically hypnotics, inducers and perpetuators of the state of sleep. The patient is only awakened to relieve himself and feed.

Although the idea of sleep as a "cure for insanity" had been around since ancient times, it was not until the late 19th and early 20th centuries that it was incorporated as a treatment for psychological disorders and associated problems. The sleep cure has its origins in the work of Jakob Klaesi (also written Kläsi) who, from the famous Burghölzli Clinic in Switzerland, spread the "prolonged sleep cure" or "prolonged narcosis" (dauernarkose in German), used for the treatment of schizophrenia from the 1920s onwards. Today it is no longer used, as we shall see.

Normally, the person to whom the treatment was applied had some psychological problem that made him/her very upset, especially if he/she had lived through a traumatic situation or had an anxiety, mood or psychotic disorder. The objective of the treatment was to get the patient's autonomic nervous system to normalize, causing her symptoms to decrease in intensity.

When a system is healthy everything is kept in order, making the person have an adequate state of health and be able to cope with the demands of their environment. However, when the disturbance occurs, the autonomic system is overloaded, activating and manifesting stress, as the body is in a constant state of alarm. This is because your body releases too high levels of adrenaline and noradrenaline, perpetuating the overexcitation.

It is for all these reasons that, throughout the history of psychology and psychiatry, the sleep cure has been proposed as an alternative treatment for various types of disordersIt would help the patient to regain some control of his life. By making him sleep for a long period of time, his organism would relax, making it possible to work on the cognitive part of his problem once he had awakened from his long lethargy, such as his beliefs and opinions or direction of his life.

Types of disorders in which it is applied

The sleep cure has been applied to many psychological problems since it was first conceptualized. Among them we can highlight traumatic experiences, suicide attempts, patients with psychosis, delusions, depressions and anxiety disorders.delusions, depressions and anxiety disorders.

The application in people who have lived through a traumatic situation is based on the hypothesis of the overactivated autonomic system. When you have lived a very upsetting situation, especially caused by the action of another person such as muggings, crimes, terrorist attacks or plane crash, there is a high activation in the nervous system, causing problems to sleep and have a proper way of relating to the world, as happens in Post Traumatic Stress Disorder (PTSD).

Benefits of the sleep cure

The main benefit of the sleep cure is that it it makes the organism recover normality, calming down. The person obtains the necessary rest to be able to face the demands of daily life in a functional way, thanks to having been immersed in a deep sleep with restorative effects.

The biological hypothesis that sustains the application of the sleep cure is that in the patients to whom it is applied they present an overactivation of adrenalin and noradrenalintogether with dopamine, a substance that passes through the mesolimbic pathway. That is why the drugs used in the sleep cure can be, among them, the classic sleep-producing drugs, especially tranquilizers such as benzodiazepines, including diazepam, alprazolam and clonazepam.

In the case of psychotic patients, antipsychotic drugs are also added, which are used while the individual sleeps. The antipsychotics currently used are the atypical antipsychoticssuch as quetiapine and olanzapine, which also produce sleep. This modulates dopamine, which at high levels is related to delusions and hallucinations. When the individual wakes up after six or seven days, his autonomic system is moderated, and the psychotic symptoms that disturb him have subsided, leaving him to the application of other therapies.

It is interesting to understand that in sleep cures for psychotic patients the application of the sleep cure is not done for the purpose of sleeping for sleeping's sake. In these psychiatric patients, antipsychotic and hypnotic drugs are applied, which work best during sleep.which work best during sleep. The patient's family could fall into the error of thinking that their relative is not being treated, but, really, the patient is in a kind of "psychiatric intensive care".

Precautions of the sleep cure

Sleep therapy requires supervision. It is not a permanent or continuous sleep for several days, as if it were a hibernation. The individual has moments when he is between sleep and wakefulness, and it is then when he gets up to relieve himself and feed. In addition, vitamins, especially B complex vitamins, are provided throughout the process.

As we have already mentioned, the treatment usually lasts between six and seven days, since this is the period of time in which the autonomic nervous system is supposed to have stabilized. Once the individual has awakened, he is supposed to have achieved greater control of his activation. It is from this point onwards that, in case the problem has been a traumatic experience, he/she will begin to see it as part of his/her past, being easier to apply psychotherapy without being altered.

It is important to understand that during induced sleep several types of drugs are administered, which may vary depending on the psychopathology being treated.These may vary depending on the psychopathology being treated. If necessary, antidepressants and antipsychotics will also be administered, always keeping an eye on their interactions with sleep-inducing drugs. This therapy has even been combined with electroconvulsive therapy.

The most recommended is to do the sleep cure in a specialized center, because, depending on the patient's age and health condition, it will require continuous monitoring by the nursing staff and the treating physician. The patient must be monitored at least once or twice a day and this is only possible in a clinic. In addition, health problems that the patient may have, such as heart, respiratory, renal or any other type of problems, will be taken into account.

In case the patient does not suffer from any physical health problems, the possibility of being cared for at home can be considered.. However, it is very important to understand that he will need a very efficient nurse at his side and that his doctor will be constantly aware of the situation. In any case, this scenario is unlikely, since in order to perform a safe sleep cure at home, the patient must be very healthy, which, considering what this procedure is used for, is already rare.

Controversy

The use of sleep cures is not a treatment widely recommended by the psychiatric community.. In fact, throughout its history, several deaths have been recorded as a result of drugs administered during sleep. Although it is true that since Klaesi devised this therapy until today different psychotropic drugs have been used and there has been a greater knowledge of the interactions between them, it is not considered entirely safe.

In fact, Klaesi himself even indicated this, given that of the 26 patients he treated with his then novel method, he recorded 3 deaths. It must be said, however, that the cause of these deaths seems to be medical problems prior to the application of the treatment.

Throughout the 20th century new forms of sleep cures were devised, which were supposedly safer. In the 1930s, Cloettal was created as a replacement for Somnifen which was attributed with less serious side effects on the Cardiovascular system. Even so, it was always necessary to have an experienced clinician nearby, since it was considered a treatment with great dangers.

Sleep therapy had its ups and downs, with its worst decade being the 1960s in Australia. There, specifically at the Chelmsford Private Hospital, between 1963 and 1979, 1115 patients were treated with sleep cures. The treatment consisted of a cocktail of barbiturates, benzodiazepines and neuroleptics and was administered discreetly by nurses. This procedure was linked to the death of 25 patients, which led to the death of 25 patients in 1980.This is why in 1980 the Royal Australian and New Zealand College of Psychiatrists considered that the use of the sleep cure with psychopathology was not justifiable.

In spite of its history, the sleep cure is still present in the popular and professional ideology, and more than one patient who, suffering from emotional disturbances or who wants to calm down, asks to be treated with this method. However, this treatment is not this treatment is not included in the official clinical practice guidelines.. Those who continue to apply it consider it an intensive therapy of psychiatry.

Bibliographical references:

• Klaesi, J. (1921), "Ueber Somnifen, eine medikamentöse Therapie schizophrener Aufregungszustände", Schweiz. Arch. Neurol. Psychiat. 8:131
• Klaesi, J. (1922), "Ueber die therapeutische Anwendung der 'Dauernarkose' mittels Somnifen bei Schizophrenen",Z. Ges. Neurol. Psychiat., 74:557.
• Stucchi-Portocarrero, S. Cortez-Vergara, C. (2020). The sleep cure in history. Rev Neuropsychiatr. 83(1):40-44 DOI: https://doi.org/10.20453/rnp.v83i1.3685