Dr Neil Stanley Independent Sleep Expert
Ekirch AR. The Modernization of Western Sleep: Or, Does Insomnia have a History?. Past & Present. 2015 Feb 1; 226(1):149-92. Because this paper is unfortunately not freely available, below I set out some of main points of Ekirch’s arguments that are not linked to footnotes. Firstly I need to point out Ekirch’s seeming obsession with class, this paper is riddled with statements concerning the upper, and particularly the middle, classes in Britain, yet he does not in any way demonstrate any class differences in sleep. Ekirch’s definition of middle class seems to be based on his perception that only they read newspapers and books, which is as patronising as it is historically inaccurate. P150 “Academic interest in sleep, aside from the study of dreams has been long overdue” This statement seems to ignore the medical and scientific literature on sleep particularly in the 19th century, although the is plenty of interest earlier than that, some of which is quoted by Ekirch himself, it therefore follow that Ekirch for some reason does not regard Doctors, Physiologist, etc. as ‘academics’. This coupled the later phrase “scholarly attention has followed in the main stream of sleep medicine” seems to imply that sleep medicine and sleep research are somehow not ‘scholarly pursuits’ which is rather confirmed by the use of the phrase on P192 “the high ground of history” which suggest that Ekirch has a rather high opinion of his discipline. P150 On what basis does Ekirch believe that sleep is “banal…to modern sensibilities” he offers no evidence for this statement? P150 “Certainly, sleep has become a major health concern of late.” Sleep per se is not “a major health concern” rather it is poor or disturbed sleep and sleep disorders that are the health problem. P151 “meanwhile, caffeinated beverages, and power naps have become popular expedients to combat the consequences of sleep deprivation” Ekirch cannot seriously be suggesting that the drinking of caffeinated beverages “to combat the consequences of sleep deprivation” is a modern phenomena. Coffee has been used for this purpose since it was first drunk in Aden in the 15th Century (for historical treatises on coffee see here and here) P151 “high-wattage lifestyle of western societies has invariably diminished the duration of human slumber.” Ekirch offers no evidence to support this statement. P151 “On work days fewer than seven hours on average for adults in the United States, The United Kingdom and Japan”. However more than seven hours sleep was found in the NSF survey quoted, here in Germany, Canada and Mexico. Therefore I am not sure what exactly Ekirch’s point is in making the statement. P151 “ Individuals have sought to compensate by improving sleep ‘efficiency’ through pharmaceutical products and high priced bedding.” No member of the public has ever spoken of trying to improve their sleep efficiency and no advert that I am aware of, for high priced bedding or anything else for that matter, has used improving sleep efficiency as a claim. P151 “As more has been learnt about segmented sleep” the problem with this statement is that other than Ekirch’s work nothing more has been learnt about ‘segmented sleep’, (probably for the very good reason that, as I have shown, it does not seem to have in fact existed). P151 “one revelation to emerge from the academic research of the last 15 years has been that Western slumber, in its current form, is remarkably young: the product of the last two centuries, not the primeval past” However it should be noticed that the only references that Ekirch gives are his own, no other researchers have independently described this phenomena. P156 “Like other forms of biological change, the evolution of modern slumber was protracted and uneven, making it difficult to trace with precision. That the transformation took place in the nineteenth century is clear” surely these statements are somewhat mutually exclusive. P156 “In recent years, some physicians and scientists on the basis of existing historical research have begun to suggest as much” However is this does not mean that they, or indeed the historical research which amounts solely to Ekirch’s papers, are right. P156 “Was sleep’s consolidation a consequence of cultural or technological change? Or even, alterations, perhaps in human physiology?” Ekirch seems to be seriously suggesting that basic human physiology can change such a fundamental process as sleep in less than two centuries. He of course does not offer a shred of evidence, from any scientific discipline, to support this statement. P156 “Moreover, of what relevance is this research to the current inability of numerous individuals to sleep through the night? Is it possible that this common form of insomnia – indeed, the most common for-rather than a disorder is instead a remnant of an older, once dominant pattern of slumber?” No reference to middle of the night insomnia (CHECK). Isn’t it equally possible that the description of first and second sleep in the past was merely a description of what we now term middle of the night insomnia? This simpler explanation, requires far fewer assumptions to be made and would not require some form of major physiological change to have occurred in the last 200 years. P157 “I have discovered numerous references to segmented slumber as well as to sleep itself” There are two problems with this statement 1) Ekirch gives absolutely no references to support it and 2) it is written in a way so to imply that there is some degree of equivalence between the number of mentions of ‘segmented slumber’ and those of ‘sleep’ which is demonstrably untrue. P157 “Containing over 500 references to first and second sleep” however despite what is, obviously deliberately, implied by Ekirch these are references to either ‘first’ OR ‘second’ sleep not first AND second sleep. And on the body of evidence the vast majority of these will be mentions merely of ‘first sleep’ and without  any indication of the context in which these phrases are used it is impossible to know whether they support Ekirch’s conception of ‘segmented sleep’ P157 “Owing to their brevity, however, the vast majority of such references were so lacking in detail as to be inconsequential, apart from confirming the widespread persistence of biphasic slumber in the nineteenth century. They provided no hint of when persons retired to bed or subsequently awakened during the night. Nor did the overwhelming number of references contain information relating to the period of wakefulness bridging intervals of sleep.” The problem with this statement is that the vast majority of references quoted by Ekirch are similarly brief and as shown in no way confirm the “widespread persistence of biphasic slumber” P158 “Although the sources for this paper are predominantly British there is no reason to suspect that patterns of sleep differed markedly in other areas if Europe” no reason except the almost complete lack of evidence from other European countries. P158 “Except northern Scandinavia, owing to the pronounced seasonal variations in the availability of natural light” Ekirch provides no references for this statement and gives no rationale for how this actually might affect the idea of segmented sleep it. P158 “Elsewhere, in all likelihood, only the pace and the timing of sleep’s consolidation were dissimilar, including in the ‘siesta cultures’ of Spain and Italy, despite the prevalence of napping to combat the intense midday heat” Ekirch gives no supporting evidence and provides no explanation for this statement. P158 “men and women may have worked later during the summer months, but longer hours of daylight ordinarily extended bedtimes and in turn, the time of ‘first rising’ by at most an hour”. Ekirch gives no support for this assertion (and why does Ekirch talk about “time of ‘first rising’” here which obviously is different from ‘first sleep’ as conceptualised by Ekirch?) P158 “In the winter, whether for conviviality or work, households remained active well after sunset” This and the above statements contradict each other whether daylight is necessary for a change in bedtime (if it is then the effect in Northern Scandinavia would be profound during the polar white nights) or it is not (then the effect in the polar winter nights would be profound). Ekirch cannot have it both ways. P159 “And yet, even then, changes were already under way in sleep patterns that would grow more pronounced in the course of the nineteenth century.” And yet, Ekirch provides no evidence for any changes occurring. P159-160 “Most obviously, the period of the first sleep increasingly fell later in the night. Rather than retiring, as did most pre-industrial households, by nine or ten o’clock and awakening shortly past midnight, by the early 1800s middle- class adults in cities and large towns were apt to stay awake for another hour or two” Ekirch provides no evidence to support these statements. P160 “Manufacturers, with heavy investments in mills and machinery, maximized productivity by operating around- the-clock with shift labour.” While no doubt historically correct I do not understand what relevance this stand alone statement has to the concept of ‘segmented sleep’, to early rinsing or to the idea of later bedtimes. P161 “In the early modern era,  first  and  second sleep had generally been of equal duration, approximately three to three and a half hours apiece. But a distinct imbalance began to emerge by the mid-1800s, marked by a gradual expansion of the first phase to five or six hours at the expense of the second.” Ekirch provide no evidence to support this statement. P163 “habitually awakened after 2am, not that unlike sleepers a century ago” yet in his previous paper he described the awakening to be around midnight, Ekirch offers no explanation for seemingly changing his mind. P165 “rural households of all ranks were more liable, like urban workers, to retire at ten o’clock and to awaken after several hours before commencing a second sleep of similar length” Interestingly Ekirch is now unspecific in this statement talking about “several” hours where previously he had been certain that it was between 3-4 hours. Page 166 “the terms ‘first’ and ‘second’ sleep began to fade from the English lexicon”. It is interesting that neither terms has been captured by the Oxford English Dictionary, which given its comprehensiveness is somewhat of a surprise P167 “Middle-class adults, in all likelihood, felt more fatigued than had previous generations upon retiring at night. With their drive to sleep heightened, they probably slept continuously for a longer duration and more soundly” Ekirch provides no evidence to support this statement nor any explanation as to why “Middle-class adults, in all likelihood, felt more fatigued” P169 “As early as 1674” is approx. 200 years earlier than the time that Ekirch states the movement for early rising started, indeed there is a lot of advocacy of early rising in what Ekirch would call pre-industrial times, at yet supposedly it had little effect till the second quarter of the 1800. Ekirch does not seem to consider that the number of articles appearing (and the repeating of articles across various publications years later) is perhaps a reflection in the increase in media outlets rather than interest in early rising. P170 Ekirch once again invokes the middle-class, this time explicitly the “urban middle class” which is somewhat contradicted by the fact that one of the publications that he uses as in this section is actually the ‘American Agriculturist’. It seems to be that Ekirch believes that the only people who read newspapers and magazines were the middle-class, without offering any evidence to support this implication. P171 “Parents were encouraged to socialize children to early rising while young habits remained unfixed.” What are “young habits” if they are not something related to children? P172 “adjustment to the new regimen” This is incorrect as the example Ekirch gives concerns “a man who resolves not to doze” There is a large difference between this and a man forgoing a ‘second sleep’. P173. “Nevertheless, the consequences of the ‘early rising’ movement, on either side of the Atlantic should not be overstated” and yet Ekirch takes it upon himself to spend considerable energy overstating the consequences. P173 “its impact was probably confined to middle class households” Ekirch give no explanation to support this statement and again seems to be implying that only middle class people read. P173 “Only a minority of which deliberately altered their pattern of slumber.” So in terms of the change to Western sleep ‘early rising’ can only have has a very small effect, certainly not sufficient to change the pre-eminent mode of sleeping by causing the population to forgo their second sleep. P169 While the formation of an early rising society was reported in a London newspaper in 1847 in London here An early rising Society has recently been formed Whitehaven, in with the Mechanics' Institution. The members meet every morning five o'clock, and employ their time holding open-air discussions, gymnastics, and searching after the various orders of British plants that may obtained in great abundance in every part the locality. it is patently clear from the article that the society was formed in, and would appear to be wholly limited to, Whitehaven in Cumbria some 300 miles north of London. According to a gazette from 1847 here it had a population of approx. 18000. The article also make it very clear that the membership of the society is limited to a small number of men in a single gym. EARLY RISING. In New York there has been formed a Young Men's Early Rising Association, all the members of which are pledged to be up at a certain hour. It began with about half a dozen men, who, having kept up this habit for some years, were surprised at its good effects, and at the marked success in life of their companions. here also ‘Early Rising’ here. Note that this association had only a few members. Ekirch’s misrepresentation of the evidence led other, such as  Reiss here, who draws extensively from Ekirch’s work, to claim that there was a “formalized” Early Rising Movement “Health reformers, in particular, promoted early rising, formalized in 1859 by the development of the “Young Men’s Early Rising Association” in New York” This is a particular piece of intellectual misdirection by Ekirch; it is clear that there are two very small societies in existence and yet he equates them to the temperance movement with millions of members in the US and claims that there were numerous such societies. He does this in order to imply that there was such a thing as an early rising movement that to a degree at least affected modern sleep when actually it was merely a fad here  P170 “The cause of early rising never spawned the numerous voluntary societies critical to the women’s rights and anti-slavery movements. It was, by its very nature, a crusade that placed a premium upon personal initiative and tenacity.” There was no “cause of early rising” and to use the phrase in the same sentence as the women’s rights and anti-slavery movements, even if there is no explicit equivalence drawn, is laughable P172 “Rather than a fixed biological drive, sleep was sufficiently pliant, in the view of some advocates, that adjustment to the new regimen required, at most, a matter of weeks.” Ekirch does not offer any evidence of someone arguing that sleep is not a “fixed biological drive”, however the pliability of sleep is mentioned repeatedly across the literature P173 “Critics of early rising were vociferous.” Ekirch provides no evidence of this vociferousness P177 “This included, during the interval of quiet wakefulness that they experienced, higher levels of prolactin, the pituitary hormone that allows chickens to brood contentedly on their nest for extended periods of time” A biologist might have here explained what prolactin does in the human rather than chickens, but as Ekirch chose to make the comparison with chickens, what biological or evolutionary purpose would a human have in secreting in the middle of the biological night a hormone that allow an animal to sit calmly for extended periods of time during both day and night? P178 Ekirch writes “What, of course, all these cultures — except for white South Africans by the early twentieth century — shared with early societies in Europe and America and, too, with Wehr’s subjects at NIMH, was a severe shortage of artificial illumination.99 (Currently, according to the United Nations, 1.5 billion people in the world remain without electric lighting, with an additional 1 billion dependent on unstable  electric networks.)”. Given these large number of people living without electric light  it is perhaps very surprising that not one research paper has been published that has found any modern society that demonstrates a pattern off sleep that resembles Ekirch’s conception of ‘segmented sleep’ On P173 Ekirch writes that early rising’s “impact was probably confined to middle class households” “Only a minority of which deliberately altered their pattern of slumber”, and yet on p179 he writes that “the growing popularity of early rising may have been both a consequence of a trend to consolidation, owing to artificial illumination and altered bedtimes, and a force in its own right, by promoting sounder and more restful sleep. So is it only a “minority” of “urban middle class households” that changed their sleep or was there “a growing popularity”. The statement that early rising was “a force in its own right” does not seem to accord with his claim that “Nevertheless, the consequences of the ‘early rising’ movement, on either side of the Atlantic should not be overstated” P181 “Eager to embrace modernity, by the early twentieth century most people never looked back” Ekirch provides no references to this statement, if this were true one would perhaps expect someone to have mentioned something resembling that they were “sleeping in the modern way” or that they had “in a desire to embrace modernity I changed my sleeping pattern” P181 “Far more common were the nouns ‘wakefulness’ and ‘watch’ or ‘watching’ to signify the absence of sleep, whether from choice or inability”. This is another example of Ekirch seemingly changing his mind without giving and explanation as to why. In his previous paper he stated that the terms ‘watch’ or ‘watching’ were used to describe the interval between first and second sleep, now he implies they are words used to describe what we now know as insomnia, and more specifically middle of the night insomnia, given that this explanation is in accord with that given in the O.E.D. this rather refutes his original contention. P181 “Whatever the historical term, MOTN insomnia the most common variety of insomnia in the United States today, afflicting 15 percent of adults, appears to have been a rare problem before the late 1800s” This is perhaps because the word ‘insomnia’ had not yet entered common usage so would not have been used to describe the phenomena making finding description of it slightly more problematical. However, what Ekirch does not seem to have considered is the possibility that descriptions of ‘first’ and ‘second’ sleep may simply have been the way of describing middle of the night insomnia before the work insomnia was widely used, again such an explanation would require far fewer assumptions to be made. Ekirch does not offer any evidence for his statement that MOTN insomnia is the most common variety of insomnia, according to research this statement is in fact incorrect “Several studies have been conducted regarding the prevalence of the insomnia subtypes (both in the population at large and within clinical subgroups). In general, each of the three phenotypes appear to be equally represented (regardless of the sample), with some limited data to support the notion that sleep initiation problems occur predominately in young individuals and sleep maintenance problems (particularly early morning awakenings) occur predominately in the elderly.” here P184 “By contrast, not until the final years of the nineteenth century and sleep’s consolidation did physicians come to view nocturnal awakenings as abnormal.” Ekirch provides no evidence for this statement. P190 “ a degree of confusion, both within and outside the medical community” Ekirch gives only a single reference to a medical textbook and one other from a newspaper to support this statement, so perhaps this statement should be more accurately written as “a incredibly small degree of confusion.” P191 “By then, of course, ‘second sleep had assumed a different meaning from its original connotation” This is one of Ekirch’s profound statements for which he sadly does not present a single reference to support. Ekirch presents not a shred of evidence for a change of meaning. P191 “No longer a natural interval of rest, it had become an unwelcome phase of broken sleep” This statement is not actually supported by the evidence that Ekirch presents on early rising, second sleep is sleep in addition to the sleep you need, and is not an indicator of broken sleep P191 “It would also be mistaken to conclude that MOTN is identical to its pre-industrial precursor. Were it possible, a rigorous clinical analysis, comparing, for example, hormonal production, body temperature, sleep time and alternating spans of REM and non REM sleep, would suggest an imperfect likeness.” Why would it be mistaken? As a scientist trespassing on the hallowed turf of the  field of history it is perhaps churlish of me to complain when a non- scientist comments outside of their own field but when a statement such as the foregoing is written naivety needs to be noted. Given we have no biological measures of pre-industrial sleep and given that no current community has anything like a pattern of sleep akin to Ekirch’s’ conception such a comparison is utterly impossible. P191 “Owing to profound changes in technology, cultural mores, diet, environmental conditions and economic activities, any closer resemblance would be surprising” The problem with this statement is that Ekirch has not in fact shown that there is any difference between MOTN insomnia and ‘segmented sleep’. P191 . “And, in some cases, there might be no likeness at all, which is to acknowledge that not all occurrences of MOTN wakefulness have a link, however imperfect, to this earlier pattern of sleep.” If in “some cases” why not in all cases? P191 “Put differently, in pre-industrial households instances of inexplicable wakefulness, not followed by a second sleep, no doubt occurred, however infrequently” Ekirch make a huge assumption that wakefulness is inexplicable yet offers now evidence of anyone describing their wakefulness as inexplicable or in another related terms. P191 “Thus for example the consumption of alcohol, which was during the early modern era used by some people to induce sleep” Ekirch seems to be unaware that alcohol has been used since time immemorial to induce sleep and that it is still the most widely used sleep aid. Pliny the Elder in his Natural History, 14.142 was certainly aware of the effects of alcohol on sleep ‘Even if all should turn out for the best, drunkards never see the rising sun, and so shorten their lives. Tippling brings a pale face and hanging  cheeks, sore eyes, shaky hands that spill the contents of vessels when they are full, and the condign punishment of haunted sleep and restless nights, and the crowning reward of drunkenness, monstrous licentiousness and delight at iniquity. P191“And yet, for all the  cautions and caveats , what nonetheless remains striking is that so many individuals, not unlike their ancestors still experience biphasic sleep, distinguished by an intervening period of wakefulness” This statement is only “striking” if one believes that segmented sleep is not the same as middle of the night insomnia. What is more likely that  segmented sleep has transitioned to middle of the night insomnia which requires numerous “cautions and caveats’” or that they are actually one in the same, which requires no assumptions to be made. Also how does any of this explain early morning waking or inability to fall asleep  if later bedtime moved the MOTN wakening later then surely there would be no early morning insomnia and people would be so fatigued having stayed up way past their “pre-industrial” bedtimes” there would be no initial insomnia. P191 “Some who are prone to nocturnal awakenings may possess particularly strong circadian rhythms, capable of withstanding the impact of artificial lighting.” Surely having a “particularly strong circadian rhythm”, whatever that means, would make these people by definition ‘abnormal’? I am not quite sure what a “particularly strong circadian rhythm” actually is, or indeed how it would allow someone to withstand the impact of artificial lighting and how it fits in to the two-process model of sleep here P191 “others congenitally disposed to resist the transition to consolidation” given that Ekirch states that the transition from segmented sleep “would take longer than one or even two centuries” then no one individual has  experienced the transition in their lifetime. Also if an individual was “congenitally disposed” then 1) the insomnia is not inexplicable and 2) they would by definition be “abnormal.” As Ekirch writes “That is slight consolation, perhaps to those whose sleep remains broken, but at the very least, this knowledge should alleviate their anxiety at night, not to mention the psychological consequences of being thought abnormal.” P192 “That is slight consolation, perhaps, to those whose sleep remains broken but, at the very least, this knowledge should alleviate their anxiety at night, not to mention the psychological consequences of being thought abnormal.” From a scientific, medical, physiological, psychological and indeed historical perspective this statement is pure bunkum P192 “Rather than the product of an inexplicable disorder, their sleep, viewed from the high ground of history, may just be natural” That small word ‘may’ is one big caveat. From the ‘high ground’ of science Middle of The Night insomnia is not by any stretch of the imagination an “inexplicable disorder”.
© Dr. Neil Stanley 2013-2018