Sleep scientist William “Bill” Dement, often referred to as “the father of sleep medicine”, has died at the age of 91. During his lifetime, Dement made many contributions that have transformed research into narcolepsy, he helped create the field of sleep medicine and his activism began a wider discussion about sleep and society.
In 1953, Nathaniel Kleitman and Eugene Aserinsky at the University of Chicago published the first clear description of what has become known as rapid eye movement (REM) sleep, the flurry of brain activity associated with dreaming. William Dement, then in his mid-20s, contributed to this work and is thought to have coined the term REM, but his role in this ground-breaking research is rarely acknowledged. “My one regret in life was that I didn’t insist on being on that paper,” he said in an interview at his home in Stanford, California in 2017.
In the years that followed, Dement began to research REM sleep in earnest, hoping it might answer the question of why we dream. It was in around 1960, while studying patterns of REM, that Dement made one of the first EEG recordings of a person with narcolepsy. Where most people do not experience their first bout of REM until around 90 minutes after falling asleep, this patient slipped directly from wakefulness into REM sleep. After moving to Stanford University in California in 1963 as a professor in the department of psychiatry and behavioural sciences, Dement put an advert in the San Francisco Chronicle looking for more people with narcolepsy. “We had a huge number of contacts, not all of which were valid of course,” he said, but he succeeded in establishing that sleep onset REM periods (SOREMPs) are virtually diagnostic of narcolepsy with cataplexy.
Looking for a way to define pathological sleepiness, Dement devised the multiple sleep latency test (MSLT), a laborious protocol that involved repeatedly recording the time it takes for someone to fall asleep. As the MSLT reveals both short sleep latency and the presence of SOREMPs, it became – and still remains – a key tool in the diagnosis of narcolepsy.
In 1972, Dement gave a presentation at the annual convention of the American Medical Association in which he showed a video of one of his patients having a cataplectic attack. Afterwards a vet approached him from the audience to say that he’d once seen something similar in a Doberman pinscher. “If there’s one, there must be more,” reasoned Dement and he put out the word amongst the veterinary community across North America that he was on the lookout for narcoleptic dogs. It was a maverick step that bore unexpected fruit. The colony of narcoleptic Dobermans that Dement and his colleagues bred over many years eventually led Emmanuel Mignot and his team to identify the cause of narcolepsy in humans, the loss of the neurochemical hypocretin from a pea-sized bundle of neurons in the hypothalamus.
Beyond his contributions to our understanding of narcolepsy, Dement played an important role in the emergence of sleep science as a medical field in its own right. In 1970, he established one of the first ever sleep disorder research centres at Stanford and began teaching a course on “Sleep and Dreams” that became an institution on campus, drawing students from many different disciplines to listen to his wisdom. He became the founding president of what is now the American Academy of Sleep Medicine and a founding editor of the journal Sleep. He made important contributions to our understanding of other sleep disorders, notably sleep apnea, which he described with Stanford colleague Christian Guilleminault in the mid-1970s. As the importance of sleep and the dangers of “sleep debt” became increasingly clear, Dement also became increasingly political, testifying in legislative hearings, acting as chairman of a national commission of sleep disorders and campaigning for more funding for sleep research.
Dement never did manage to work out what REM is all about, a question that remains something of a mystery even today, but this was something he’d come to terms with. “I created a whole new clinical discipline. I’ll take that,” he said. “We have saved lives. Lots of lives."
William Dement was born on 29 July 1928 and died in his sleep on 17 June 2020, just short of his 92nd birthday.