Sleep Cure: What It Is, How It Was Used, And Why It Is Not Recommended

Sleeping well is essential to be able to have a healthy life. For this reason it is not surprising that when psychological problems appear, such as stress, depression or serious psychiatric disorders, they have problems falling asleep.

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

The sleep cure is a treatment that has been applied in people with diverse psychopathology, and it is not without controversy.. Next we will take a more in-depth look at this practice, called “intensive therapy” in the psychiatric setting.

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What is the sleep cure?

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

To get the person to sleep so long you are given various types of psychotropic drugs

, specifically hypnotics, inducers and perpetuators of the dream state. The patient is only awakened to relieve himself and feed himself.

Although the idea that sleeping is "a cure against madness" had already been related since ancient times, it was not until late nineteenth and early twentieth centuries that was incorporated as a treatment for psychological disorders and problems associates. The sleep cure has its origins in the works of Jakob Klaesi (also written Kläsi) who from the famous Burghölzli Clinic in Switzerland spread the "long sleep cure" or "Prolonged narcosis" (dauernarkose in German), used for the treatment of schizophrenia from the decade of 1920. Today it is no longer used, as we will see.

Normally, the person to whom the treatment was applied had some psychological problem that made him feel very altered, especially if you had experienced a traumatic situation or have an anxiety disorder, mood or psychotic. The objective of the treatment was to get the patient's autonomic nervous system to normalize, causing his 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 can cope with the demands of their environment. However, when the alteration occurs, the autonomous system becomes overloaded, activating and manifesting stress, since the organism is in a constant state of alarm. This is because your body releases too high levels of adrenaline and norepinephrine, perpetuating overexcitement.

It is for all this that, throughout the history of psychology and psychiatry, sleep cure has been proposed as an alternative treatment for various types of disorders, since it would help the patient to regain some control of her life. By putting him to sleep for a long period of time, his body would relax, making it possible to work the part cognitive awareness of their problems once they have awakened from their long slumber, such as their beliefs and opinions or direction of their lifetime.

Types of disorders in which it applies

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

The application in people who have experienced a traumatic situation is based on the overactivated autonomous system hypothesis. When a very disturbing situation has been experienced, especially caused by the action of another person such as robberies, crimes, terrorist attacks or a plane crash, there is a high activation in the nervous system, generating problems sleeping and having an adequate way of relating to the world, as happens in Post-Traumatic Stress Disorder (PTSD).

Sleep cure benefits

The main benefit of the sleep cure is that makes the body return to normal, calming down. The person obtains the necessary rest to be able to functionally face the demands of daily life, thanks to having been plunged into a deep sleep with restorative effects.

The biological hypothesis that supports the application of the sleep cure is that in the patients to whom it is applied they present an over-activation of adrenaline and norepinephrine, along 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 drugs that make you sleepy, especially tranquilizers such as benzodiazepines, including diazepam, alprazolam, and clonazepam.

In the case of psychotic patients, antipsychotic medications are also added, which are used while the individual sleeps. Currently used antipsychotics are atypical, such as quetiapine and olanzapine, which also make you sleepy. In this way dopamine is modulated, which at high levels is related to suffering from delusions and hallucinations. When the individual wakes up after six or seven days, his autonomic system is moderate, and psychotic symptoms that disturb him have subsided, giving way to the application of other therapies.

It is interesting to understand that in sleep cures for patients with psychotic pictures the application of the sleep cure is not done in order to sleep to sleep. In these psychiatric patients, antipsychotic and hypnotic medications are applied, which work best during sleep. The patient's family could fall into the error of thinking that nothing is being done to his relative, but, really, the patient is in a kind of “psychiatric intensive care”.

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Sleep cure precautions

Sleep cure requires supervision. It is not about 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 that is when he gets up to relieve himself and feed himself. In addition, vitamins that you need are supplied throughout the process, especially the B complex.

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

It is important to understand that several types of drugs are given during induced sleep., which may vary depending on the psychopathology that you are trying to treat. If necessary, antidepressants and antipsychotics will also be given, always monitoring their interactions with drugs that induce sleep. This therapy has come to be combined with electroconvulsive therapy.

The most recommended is to do the sleep cure in a specialized center, because, depending on the age of the patient and of your health condition, will require continuous monitoring of the nursing staff and the doctor who is treating you. You should be aware of the patient at least once or twice a day and this is only possible to do in a clinic. In addition, health problems that the patient may have, such as heart, respiratory, kidney or any other type of problems will be taken into account.

In case the patient does not suffer from any physical health problem, the possibility of being cared for at home can be considered. However, it is very important to understand that you will need a very efficient nurse by your side and that your doctor is constantly aware of the situation. In any case, this scenario is unlikely, since in order to carry out a safe sleep cure at home it is It is necessary for the patient to be very healthy, something that, taking into account what this procedure is used for, is already weird.

Controversy

The application of the sleep cure it is not a widely recommended treatment by the psychiatric community. In fact, throughout its history there have been several deaths due to drugs administered during sleep. Although it is true that since Klaesi devised this therapy until today different psychotropic drugs and there has been a greater understanding of the interactions between them, it is not fully considered safe.

In fact, Klaesi himself even indicated it, since of the 26 patients he treated with his method, at that time novel, he registered 3 deaths. It must be said, however, that the cause of these deaths appears 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 30s the Cloettal was created, replacing the Somnifen which was attributed less serious side effects on the cardiovascular system. Still, a seasoned clinician should always be around as it was considered a dangerous treatment.

The sleep cure was having its ups and downs, 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. Treatment consisted of a cocktail of barbiturates, benzodiazepines, and neuroleptics and was administered discreetly by nurses. This procedure is related to the death of 25 patients, which is why in 1980 the Royal College of Psychiatrists of Australia and New Zealand considered that the use of the dream cure with psychopathology was not justifiable.

Despite its history, the sleep cure is still present in the popular and professional ideology, reaching more than a patient who, suffering from emotional disturbances or who wants to calm down, requests to be treated with this method. Nevertheless, this treatment is not within the official clinical practice guidelines. Those who continue to apply it consider it an intensive psychiatric therapy.

Bibliographic 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 dream cure in history. Rev Neuropsychiatr. 83 (1): 40-44 DOI: https://doi.org/10.20453/rnp.v83i1.3685