For thousands of years, humans slept in two shifts. Should we do it again?

Researchers believe that the practice of sleeping through the whole night didn’t really take hold until just a few hundred years ago.

She was wide awake and it was nearly two in the morning. When asked if everything was alright, she said, “Yes.” Asked why she couldn’t get to sleep she said, “I don’t know.” Neuroscientist Russell Foster of Oxford might suggest she was exhibiting “a throwback to the bi-modal sleep pattern.” Research suggests we used to sleep in two segments with a period of wakefulness in-between.

A. Roger Ekirch, historian at Virginia Tech, uncovered our segmented sleep history in his 2005 book At Day’s Close: A Night in Time’s Past. There’s very little direct scientific research on sleep done before the 20th century, so Ekirch spent years going through early literature, court records, diaries, and medical records to find out how we slumbered. He found over 500 references to first and second sleep going all the way back to Homer’s Odyssey. “It’s not just the number of references—it is the way they refer to it as if it was common knowledge,” Ekirch tells BBC.

“He knew this, even in the horror with which he started from his first sleep, and threw up the window to dispel it by the presence of some object, beyond the room, which had not been, as it were, the witness of his dream.” — Charles Dickens, Barnaby Rudge (1840)

Here’s a suggestion for dealing with depression from English ballad ‘Old Robin of Portingale’:

“And at the wakening of your first sleepe/You shall have a hott drinke made/And at the wakening of your next sleepe/Your sorrowes will have a slake.”

Two-part sleep was practiced into the 20th century by people in Central America and Brazil and is still practiced in areas of Nigeria.


(Photo: Alex Berger)

Night split in half

Segmented sleep—also known as broken sleep or biphasic sleep—worked like this:

  • First sleep or dead sleep began around dusk, lasting for three to four hours.
  • People woke up around midnight for a few hours of activity sometimes called “the watching.” They used it for things like praying, chopping wood, socializing with neighbors, and for sex. A 1500s character in Chaucer’s Canterbury Tales posited that the lower classes had more children because they used the waking period for procreation. In fact, some doctors recommended it for making babies. Ekirch found a doctor’s reference from 16th century France that said the best time to conceive was not upon first going to bed, but after a restful first sleep, when it was likely to lead to “more enjoyment” and when lovers were more likely to “do it better.”
  • “Second sleep,” or morning sleep, began after the waking period and lasted until morning.

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Why and when it ended

Given that we spend a third of our lives in slumber, it is odd that so little is known about our early sleep habits, though Ekirch says that writings prove people slept that way for thousands of years. If for no other reason, someone had to wake in the middle of the night to tend to fires and stoves.

Author Craig Koslofsky suggests in Evening’s Empire that before the 18th century, the wee hours beyond the home were the domain of the disreputable, and so the watching was all the nighttime activity anyone wanted. With the advent of modern lighting, though, there was an explosion in all manner of nighttime activity, and it ultimately left people exhausted. Staying up all night and sleepwalking through the day came to be viewed as distastefully self-indulgent, as noted in this advice for parents from an 1825 medical journal found by Ekirch: “If no disease or accident there intervene, they will need no further repose than that obtained in their first sleep, which custom will have caused to terminate by itself just at the usual hour. And then, if they turn upon their ear to take a second nap, they will be taught to look upon it as an intemperance not at all redounding to their credit.” Coupled with the desire for efficiency promoted by industrialization, the watch was increasingly considered a pointless disruption of much-needed rest.

The rise of insomnia

Intriguingly, right about the time accounts of first sleep and second sleep began to wane, references to insomnia began appearing. Foster isn’t the only one who wonders if this isn’t a biological response to un-segmented sleep. Sleep psychologist Gregg Jacobs tells BBC, ”For most of evolution we slept a certain way. Waking up during the night is part of normal human physiology.” He also notes that the watch was often a time for reflection and meditation that we may miss. “Today we spend less time doing those things,” he says. “It’s not a coincidence that, in modern life, the number of people who report anxiety, stress, depression, alcoholism and drug abuse has gone up.” It may also not a coincidence, though, that we don’t die at 40 anymore.

Subjects in an experiment in the 1990s gradually settled themselves into bi-phasic sleep after being kept in darkness 10 hours a day for a month, so it may be the way we naturally want to sleep. But is it the healthiest way?

Science says we’re doing it right right now

Not everyone restricts their rest to a full night of sleep. Siestas are popular in various places, and there are geniuses who swear by short power naps throughout a day. Some have no choice but to sleep in segments, such as parents of infants and shift workers.

But, according to sleep specialist Timothy A. Connolly of Center of Sleep Medicine at St. Luke’s Episcopal Hospital in Houston speaking to Everyday Health, “Studies show adults who consistently sleep seven to eight hours every night live longest.” Some people do fine on six hours, and some need 10, but it needs to be in one solid chunk. He says that each time sleep is disrupted, it impacts every cell, tissue, and organ, and the chances go up for a range of serious issues including stroke, heart disease, obesity and mood disorders.

Modern science is pretty unanimous: Sleeping a long, solid chunk each night gives you the best chance of living a long life, natural or not.

BY: ROBBY BERMAN

* This article is a repost which originally appeared on BIG THINK.

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Forecasted Physician Shortfall

In April, the Association of American Medical Colleges released a report suggestive of an oncoming physician shortfall in the United States in The Complexities of Physician Supply and Demand: Projections from 2017 to 2032. According to data from the study, the U.S. could face a shortage of nearly 122,000 physicians by 2031, as the demand for doctors increases faster than supply. Projected shortfall estimates range from 47,000 to 122,000 physicians however, that number could be even higher.

As the national population continues to grow and age, the need for a larger number of doctors available to meet the rising demand increases. While the industry continues to address and reduce population health factors such as smoking, heart disease, and obesity, it also extends American life expectancy, thereby creating an increased demand for doctors. The U.S. Census Bureau estimates the nation’s population to grow by more than 10% by the year 2032, with the number of people over the age of 65 increasing by nearly 50%.An aging population not only demands more healthcare opportunities, but it also reduces the amount of practicing physicians. Currently, one-third of all doctors will reach the age of 65 or older within the next decade, making physician retirementone of the greatest potential causes of the projected shortfall. Additionally, prevention efforts and longer life expectancy are expected to decrease demand for some specialties, such as endocrinology, while increasing the need for others, like geriatric medicine.While rural and underserved areas may experience the forecasted shortage most acutely, the demand for doctors will be felt across the nation. To help address this problem, the United States would need an additional 95,900 physicians immediately if health care use patterns were to be equalized across race, insurance coverage and geographic location. The report’s estimated number of lacking physicians may need to increase to account for these needs.

The total projected shortage persists under multiple studied scenarios including: a moderate increase in the use of advanced practice nurses (APRNs) and physician assistants (Pas), greater use of alternate settings such as retail clinics, and delayed physician retirement. Thus, the magnitude of the forecasted shortage will necessitate more than a single solution. Addressing the issue will require a multifaceted approach focused on innovation in healthcare delivery methods, optimal use of technology, efficient use of all healthcare professionals, and increased federal funding.

Seeing as physician training can last up to a decade, the problem should be addressed as soon as possible. Currently, the AAMC and 70 healthcare stakeholders are backing legislation that would add 15,000 Medicare-supported residency positions to the market between 2021 and 2025. In the latest press release, AAMC President and CEO, Dr. Darrell G. Kirch stresses the need for immediate action: “Because it takes seven to 15 years to train a doctor, we urge Congress to remove the freeze on federal funding for residency training that has been in place for over two decades without delay.”

The study is an update to last year’s report, incorporating the latest data evidence to present the most accurate estimates and solutions based on new healthcare modeling. As new data becomes available, the AAMC pledges to update the study annually and ensure the most precise projections are being addressed.

BY: ZUZANNA WALTER
* This article is a repost which originally appeared on The A4M Blog
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