In April of 2004, only a few months into my fieldwork, I was struck by the level and variety of doubt expressed by the physicians at the Midwest Sleep Disorder Center (MSDC). The MSDC is a group of physicians recognized in the field as experts in many areas of sleep medicine, especially parasomnias—such as sleepwalking, sleep-related eating, and REM behavior disorder. Dr. Richards, the clinic's senior researcher and a neurologist by training, began the weekly departmental rounds. Generally, these consisted of case studies presented by the assembled clinicians and fellows, but at times rounds wandered into more philosophical discussions or ribald joking. On this day, Dr. Richards asked Dr. Pym if he had seen any patients of note. Pym was trained as a pediatrician, and his patients, at both the MSDC and the neighboring Children's Hospital, were mostly adolescents and young children. Pym had been in Nicaragua for the previous three weeks as part of a volunteer program to provide medical aid to the rural poor, and so had no cases, but he took the opportunity to make some observations on sleep disorders in Central America. He remarked that most of the places he had been to had about eleven hours of night and thirteen of daylight, and with only intermittent electrical lighting in the evening, most people went to bed at nightfall and arose with the sun. As a result, he postulated, most of the sleep disorders that physicians dealt with in the United States were not found there. He went on to blame electric lighting for many of the sleep problems in the United States—including insomnia and advanced and delayed sleep phase disorders—since it negatively affected biological impulses to sleep. Pym claimed that sleep disorders were “rare” in Nicaragua. He said most children there slept with their parents, who attended to their sleep problems as they happened, and so they did not develop into more acute pathological forms. This led into a broader conversation about light and its effects on human sleep patterns, in which some of the discussion revolved around sleeplessness in intensive care units; apparently, Richards reported, many people never entered REM sleep while in the units due to lighting disruptions, which, he said, might account for “ICU psychosis,” as people hallucinated due to sleepiness. At this point, Dr. Blake, a young pediatrician, remarked in relation to the newness of sleep medicine, “We're all flying by the seats of our pants,” to which Richards said, “We don't know anything.”
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