In considering the founding and development of the major sleep societies , it is useful to recall that the entire process is ultimately about people and the exchange of ideas. This “history” is a personal (CG) one and its narrative is inspired by individuals who shared a passion and interest in advancing sleep medicine.

The first sleep society created was the “Association for the Psycho-physiological Study of Sleep” or APSS. It was created by William C. Dement as an informal society where individuals interested in the investigation of sleep could interact. At that time, there were no clear standards to score sleep and wakefulness in laboratory animals or in humans and there was the need to have a forum where ideas could be exchanged between researchers. Its initial members were few but it had an international representation. Individuals integrating sleep and circadian rhythms as well as those interested in sleep and dreams were involved. The early members included many enthusiastic individuals attracted by this new field of research, e.g., Michel Jouvet, Danielle Mounier, Allan Rechtschaffen, Eliot Weitzman, Howard Roffwarg, Michael Chase, Gerald Voegel, Laverne C. Johnson, Rosalind D. Cartwright, Wilse Webb, Truett Allison, Ralph Berger, Frank Snyder, Ismet Karacan, Charles Fisher, Milton Kramer, David Foulkes, Thomas Anders, Allan Hobson, M. Barry Sterman, Peter Hauri, Antony Kales, Walter Baust, Werner Koella, Pier Parmegggiani, Peter Morgane, Olga Petre-Quadens, and Ian Oswald. These participants helped develop structure and purpose for the group.

In addition, there were specific places that quickly became important to the study of sleep and generated increasing interest and membership. In the USA, Chicago, New York, and Stanford became especially influential. Dement, working at Stanford, the University of California, Los Angeles (UCLA) group, and the navy hospital in San Diego brought many individuals into the society. These members included the following: Vincent Zarcone, Georges Gulevitch, Jon Sassin, Ardie Lubin, Denis McGinty, Anna Taylor, and Ronald Harper. In Lyon, France, Marc Jeannerod, and Odile Benoit were brought into the fold. Not everyone was convinced, however, of the utility of binding common interests.

In particular, two individuals were missing from this effort: Nathaniel Kleitman and Eugene Aserinsky. Much later, Nathaniel Kleitman explained his lack of involvement in this way when speaking with one of the authors (CG) of this chapter about rapid eye movement (REM) sleep, “this is the stuff of Dement.” The implication was that this was not his primary interest. Greater importance was placed on the understanding of the sleep rhythms in general, with REM sleep being only one of them.

There were clear divisions of interest within sleep. There were a large number of individuals interested in the electrophysiology, pharmacology, and cellular mechanisms of sleep . Still others were more focused on “sleep and dreams.” Some people pursued the interactions between seizures and sleep or on other brain disorders and sleep. Finally, there was a small group who was interested in the development of sleep from infancy to childhood. Many times it proved difficult to unite these divergent interests into a common set of purpose and agenda. It became clear early on that it was necessary to develop a common language when considering sleep in humans. Moreover, it was critical to “codify” the electroencephalography (EEG) changes seen when monitoring the brain, in either animals or humans. One of the major early accomplishments of this heterogeneous group, brought together in part by Dement, was the creation of two sleep atlases that are still used today. This was no small feat.

In order to develop these standards, numerous initial obstacles had to be overcome, including differing techniques and equipment. In North America, the standard equipment used to investigate sleep was the “Grass recorder.” In Europe, where sleep was part of the tools used by clinical neurophysiologists in their search for seizure disorders, the most common recorder was the Alvar^TM equipment. Even the speed at which the paper moved through the equipment varied. In general, a large amount of recording paper was needed to study sleep, but the goals were often different. EEG specialists wanted to see many EEG leads at a fast speed. However, individuals investigating “sleep and dreams,” or the body phenomena associated with sleep onset, were more parsimonious with paper. They wanted to recognize non-REM and REM sleep as well as other phenomena. The basic recording speed was 20 s per epoch in western Europe and 30 s per epoch in the USA. Compromise was eventually reached, but only after individuals committed to their interests were involved (sometimes following heated battles).

One hard-working individual was Dr. Dreyfuss-Brissac in the Port Royal Maternity Hospital in Paris. She was involved in continuous monitoring of premature and newborn infants . She also had an integral role in educating a large number of infant sleep researchers in western Europe. She faced off with Dement who was looking to understand REM sleep in humans and the possible use of sleep recording to investigate psycho-physiology and the role of sleep, and particularly REM sleep deprivation, a research topic far separated from an understanding of the development of sleep in premature infants. These had been quite divergent goals for many years. In Europe, many more EEG leads than in USA were used in monitoring, reflecting very different agendas of the sleep researchers. To their credit, these individuals ultimately knew how to compromise and were able to join efforts to set minimum standards and create a work that is still today the basis of human sleep recording.

The informal gathering of the early APSS became more structured with advancing years. Dement was always a driving force behind this group, pushing the development of the field. He understood that there was the need for a unified front if basic sleep research were to gain a foothold in the National Institute of Health grant funding. Cohesion and growth were central in his view to advance the field of sleep research. The presentation of scientific results in front of peers, as is the standard in many other fundamental research fields, was the only way to have recognition of sleep as a valid, independent, scientific field. Dement had many friends who joined him in these efforts, but two were important at this stage: Allan Rechtschaffen and Michel Jouvet.

Both Dement and Jouvet were fascinated by REM sleep and were dedicated to understanding its mechanisms as well as the development and maintenance of the state of alertness. Both gave the impression of being “REM or paradoxical sleep scientists.” They both had great mutual respect for each other’s work. Jouvet would come and visit Dement regularly in the basement of the Stanford anatomy building where cats and mice were continuously monitored. They exchanged data and discussed hypotheses. As funding was still difficult for sleep research in France (even though Jouvet had a much more luxurious university setting compared to Dement), Dement played a critical role in supporting Jouvet on a project submitted to the US Air Force. They also jointly supported the advances presented at the now yearly meetings of the APSS more than any other scientists in the field.

The APSS was still a young society with little formal activity between annual meetings. The organization of the meetings that did occur was thus vitally important. It was coordinated by senior investigators and always located in the USA. The cost of travel was still high for the Europeans and Japanese, who were the two major groups joining the research efforts on sleep. In 1970, the USA was in the middle of an important crisis related to the war in Vietnam. The APSS annual meeting was scheduled to be in Santa Fe, New Mexico in the mid-spring. Snow was still on the surrounding mountains, but the sun was everywhere in the small town. The meeting occurred in a room that could contain about 150 people. Many were young college students taking a year off to do research as pre- and postdoctoral fellows. The APSS had succeeded in attracting young individuals securing its chance to survive over time. The Dement group was the largest with Stephen Henricksen, James Ferguson, Eric Hoddes, as well as young associates from Jack Barchas’s biochemistry laboratory and the neurophysiology laboratory of Dr. Chow. There were foreign scientists, not only Jouvet and Olga Petre-Quadens but also Swedish scientists, particularly K. Fuxe and Anita Dahlstrom indicating the extension of their interest in the field of sleep research. It was decided that the next meetings would be held internationally every 5 years opening opportunities for foreign young scientists to come and listen to the senior researchers from other parts of the world.

It was also at this meeting that two very different groups met for the first time: the European neurologists who had studied disorders of sleep within the context of neurological disorders and the US-based “sleep researchers” who had created the APSS. The scientific symposium was organized under the guidance of Roger Broughton who had been a student of Henri Gastaut (the individual who could have created the field of sleep medicine, but did not believe in it). Elio Lugaresi, Alberto Tassinari, Pierre Passouant, and Bederich Roth represented European neurology. They did not see a new field, but rather a subdiscipline of neurology, an error that pulmonary specialists repeated later on after investigation of the sleep apnea syndrome . Despite their support for the investigation of the brain during sleep, it was clear that it was viewed as only a small part of neurology, the “noble science,” and not a new field. Ten years later, Elio Lugaresi was invited to another international sleep meeting where he indicated his strong views on the subject in a conversation involving Dement and Guilleminault, stating, “Do you realize that you are making me a simple sleep researcher, when I am a Neurologist?” Clearly, following Gastaut, most of the famous neurologists did not want the label of “sleep researchers.” What was sleep when you were the head of the Neurological Institute? Sleep was viewed as a minor segment of neurology. Two years later, Pierre Passouant expressed the same views when he decided to send Michel Billiard for one year to Stanford; sleep was to be part of a great neurology department. Such philosophy persisted in Montpellier until the second millennium. The term sleep department never emerged, but the sleep laboratory (probably one of the largest in Europe for a long time) was part of the department of neurology of the Montpellier Medical School in France. In some respects, the first international APSS congress demonstrated the isolation of the few individuals who wanted to create a new research discipline, a primary goal of the APSS. In addition, the European neurologists realized that there was a complete absence of the concept of a clinical discipline, and that the APSS was essentially an American-based sleep research society including PhDs with little clinical interest or expertise. And, at that time, none of the senior members of the APSS were interested in clinical sleep medicine.

One individual (CG) had a very different view. He attended the 1970 APSS meeting and had decided that there was a new discipline that he called sleep medicine. CG opened a sleep medicine laboratory in La Salepetriere Hospital, against the desire of his chair and dean. Through contact with his contemporary colleagues who also had just finished or were finishing their residencies, CG monitored adults and children from different departments, including internal medicine, metabolism and endocrinology, and pediatrics. He was effectively alone, having only the help of young individuals he taught such as interns and medical students. The only professional support was from his direct colleagues that he had spent the past 4 years with in that very large hospital in Paris. He was financially supported by a one-year grant from the “Societe Medicale des Hopitaux de Paris.” In June 1971, he attended the first international meeting in Bruges and the future did not look promising; the same head of La Salpetriere neurology department was not supportive of his venture, despite the fact that the laboratory had been a success with more than 400 sleep medicine patients monitored in a two-bedroom EEG laboratory. During a lunch break with Vincent Zarcone, who was doing alcohol and sleep research at the Palo Alto VA Hospital and who also worked at the animal sleep laboratory of Dement, CG expressed his views and his belief in a new specialty called sleep medicine. Returning to California, Zarcone learned that Dement wanted to secure a large grant to investigate narcolepsy as a disorder of REM sleep incorporating both animal and human research for a better understanding of REM sleep. Neurologists were not interested as it was mostly a low-paid research position based on a grant. Zarcone suggested that Dement should contact Guilleminault, which he did in August 1971. Guilleminault was initially not very interested, considering the conditions and the focus on only narcolepsy and not on sleep medicine, including adults and children. As his situation deteriorated in France within the following four months, Guilleminault agreed to go to Stanford and arrived on January 4, 1972, to take the position and participate in the write-up of a very large grant on narcolepsy. He succeeded in including 10 pages (out of the 300 of the total grant) on breathing and heart monitoring in adults and children. The grant was funded and most of the next three years were used to perform the work outlined in those 10 pages.

Meanwhile, Anthony Kales at UCLA had opened a human sleep and pharmacology unit and was performing research for the pharmaceutical industry, testing the effects of hypnotics on sleep of normal volunteers and insomniacs. Dement saw a way to support basic research through similar funds from pharmaceutical research. The Dement laboratory had most of its research focused on animal models and on narcolepsy as a disorder of REM sleep. There was a postdoctoral fellow, Terry Pivick, who was doing a research project on sleep in pregnant women , monitoring them in the medical center in a two-bedroom laboratory. Recruitment for pharmacological studies on insomnia was also happening there. It was decided that studies on narcoleptics would also be performed in the same place. The recruitment of patients complaining of insomnia quickly expanded to include various sleep disorders. A young neurologist, Dr. Robert Wilson, doing a year of fellowship was there to help, and CG pushed forward with his idea to develop a sleep disorders clinic. Pursuing his own interest, CG went to the Veterans Administration Hospital to work in collaboration with pulmonary medicine (Dr. Fred Eldridge, the senior researcher) and cardiology (Dr. Ara Tilkian, a fellow in cardiology). He attracted the interest of the head of the pediatric intensive care unit (ICU; Dr Philip Sunshine) whose office was just opposite the two-bedroom sleep laboratory, in referring infants and children for monitoring and evaluation of sleep complaints. Adding the information collected in Paris to that gathered at Stanford, new findings became apparent and CG was able to present these at an international meeting organized by Elio Lugaresi on Pickwickian syndrome and hypersomnia. Guilleminault and Dement had many discussions on the possibility of creating a clinical service where money would be obtained for services and tests. But at the 1972 APSS meeting, the presentation of clinical results fell mostly on deaf ears. The society was much more focused on fundamental research and not interested in any clinical endeavor. William Dement was himself somewhat ambivalent: pharmaceutical research was very different from the creation of a clinical field. For many years, the goal of advancing sleep research would be the primary concern for Dement, and the goal of creating a clinical field of sleep medicine remained primarily with Guilleminault. Nevertheless, these two goals were complementary to ultimately create a specialty of sleep medicine, establish a sleep center at the National Institutes of Health (NIH), and have a medical board recognized by Educational Council for General Medical Education (ECGME). Before any of these achievements, it became quickly apparent that the APSS was not the avenue to create such a clinical field. In fact, many participants were outright opposed to it. The senior members of the APSS were already appointed to faculty positions within well-established departments, and there was no reason to disrupt this well-organized order with a well-established line of advancement and research support. The only individuals who could be interested were young individuals who were not established and thus had nothing to lose, or good friends who wanted to change careers and aim for something different.