Citation:
LaBarbera V, Marsella J. Media review: The Nocturnal Brain—Nightmares, Neuroscience, and the Secret World of Sleep by Guy Leschziner. J Clin Sleep Med. 2021;17(1):113–114.
The Nocturnal Brain: Nightmares, Neuroscience, and the Secret World of Sleep by Guy Leschziner is a compilation of clinical vignettes, akin to Oliver Sacks’s memorable work The Man Who Mistook His Wife for a Hat. As a neurologist and sleep physician, Dr. Leschziner describes extreme cases that he has cataloged during his career at the Sleep Disorders Centre at Guy’s Hospital and at London Bridge Hospital. Each case is presented alongside the clinical, pathophysiological, and historical basis for the respective sleep disorders—like Eugene Aserinsky’s serendipitous (and humorously self-deprecating) role in the discovery of rapid eye movement sleep—in addition to the cultural context in which the patient lived, such as the man who was convicted for crimes later attributed to a diagnosis of sexsomnia or the young woman of Ugandan descent whose sleep paralysis was thought by some to be linked directly to black magic “juju.” This collection portrays patients and their loved ones in a very real and tangible style. It is evident in this well-written, yet easy-to-read, collection that Dr. Leschziner’s patients divulged their stories in order to help introduce to the reader these common (and not-so-common) conditions. Dr. Leschziner’s pleasant writing style notably sheds light on the real human experience endured as a result of their diagnoses.
An endearing aspect of this work is the way that Dr. Leschziner writes his prose – almost as if it is a conversation, relaying an interesting case to a colleague. He does not deliver the patient’s story in the dry way of a case report presented in a journal or textbook. Instead, he skillfully writes in a manner that intermingles history, culture, ethics, sociology, and law, and elucidates various facets of the patient as a person, and not just a clinical diagnosis. Background descriptions, such as the Korean War–era survival tactics for POWs to cope with extreme abuse in the form of sleep deprivation and the analogy of the incubus and horse in Henry Fuseli’s famous 1782 painting, The Nightmare, make the portrayals of the patients quite genuine, as if they are sitting in your clinic waiting room. In this way, The Nocturnal Brain is written not just for the clinician but for anyone interested in the humanistic side of medicine.
As a trainee in neurology myself, I find that Dr. Leschziner depicts his clinical upbringing in a manner familiar to my own. Each case comes with a review of the pathology of the respective disorder, with neurologic localization faring prominently in these discussions. These descriptions do not reach the level of comprehensiveness that a textbook in sleep medicine would offer. However, to the casual reader who does not practice sleep medicine (or neurology), the depth of discussion has the “just right” feel, so that it does not take away from the flow of the narrative piece but is enough to highlight to the reader the most pertinent anatomy and physiology. For example, the chapter devoted to nocturnal epilepsy houses a basic review of the cerebral cortices, using Penfield’s seminal work in mapping out the homunculus as the anchoring point, but also includes a foray into the insular cortex and operculum, which many readers may not recall from their experience with brain cutting in the cadaver laboratory. In addition, each individual chapter is short enough to read in one sitting, which adds to the digestibility, as I read this book in between consults and stroke code activations in the emergency department.
Evocative chapter titles like “Floating Eyeballs,” “Buzzing Bees,” and “Jekyll and Hyde” offer a peek into the content of the chapter, which, for an experienced clinician, may be enough to disclose the diagnosis. With that said, even if the ultimate diagnosis of the chapter is not surprising, the unfolding of the story still provides new insights into the conditions listed. Dr. Leschziner’s reflections on his patients serve as a poignant reminder for all clinicians of the mysterious nature of sleep, and of the privilege of working with patients.
This book proved to be a worthwhile read, highlighting key sleep medicine disorders, but more importantly, providing the reader with a new vantage with which to see our patients in the clinic. I would highly recommend this book to colleagues in medicine who want to broaden their horizons about sleep medicine, but also to anyone looking for an entertaining nonfiction summer read. While the diagnoses in this book may not be new or exotic to the sleep medicine provider, little nuggets of history, the arts, and sociology make this piece of work novel, fascinating, and, in my opinion, worth the read.
DISCLOSURE STATEMENT
The authors report no conflicts of interest.