Sleep paralysis in medieval Persia – the Hidayat of Akhawayni
By Samad EJ Golzari et al.
Neuropsychiatric Disease and Treatment, No.8 (2012)
Abstract: Among the first three manuscripts written in Persian, Akhawayni’s Hidayat al-muta’allemin fi al-tibbwas the most significant work compiled in the 10th century. Along with the hundreds of chapters on hygiene, anatomy, physiology, symptoms and treatments of the diseases of various organs, there is a chapter on sleep paralysis (night-mare) prior to description and treatment of epilepsy. The present article is a review of the Akhawayni’s teachings on sleep paralysis and of descriptions and treatments of sleep paralysis by the Greek, medieval, and Renaissance scholars. Akhawayni’s descriptions along with other early writings provide insight into sleep paralysis during the Middle Ages in general and in Persia in particular.
Introduction: Sleep paralysis, a rapid eye movement (REM) parasomnia, is characterized by a period of inability to perform voluntary movements at sleep onset (hypnagogic form) or upon awakening (hypnopompic form). During sleep paralysis, although limb, trunk, and head movements typically are not possible, ocular and respiratory movements are intact. The experience is frequently accompanied with panic, enhanced by the inability to speak or breathe. Sleep paralysis occurs as an isolated form, in a familial form, and as one of the classic tetrad of narcolepsy symptoms. Apart from therapeutic approaches toward sleep paralysis, controversial reports exist in the literature regarding its early description. Accordingly, the earliest description of sleep paralysis dates back to 1664 by the Dutch physician Isbrand van Diemerbroeck. In almost all the earlier descriptions, the word “night-mare” has been used to portray sleep paralysis.
Persia has a long history of medical practice and study. During the Middle Ages, scholars of different religions, such as Muslim, Christian, or Jewish, contributed to the development of Islamic medicine, later influencing the rise of European science during the Renaissance. Thanks to the translation and assimilation period (ca 750–900), the Samanid dynasty (819–999) coincided with the appearance of the renowned scholars Muhammad ibn Zakariya al-Razi or Rhazes (ca 865–925), Ali ibn al-Abbas al-Majusi or Haly Abbas (930–994), and Abu-Ali al-Husain ibn Abdollah ibn Sina or Avicenna (981–1037). These polymaths were not only responsible for accumulating all the existing information on medicine of the time but adding to this knowledge by their own perceptive observations, trials, and skills. In the era of Arabic language domination in the scientific literature, Hakim Maysari, Abu Mansur Muvaffak Harawi, and Akhawayni Bokhari were three first authors who wrote their treatises in Persian. Hakim Maysari composed medical poems (Danishanameh) in 980. Harawi compiled the Book of the Remedies (Kitab al-Abnyia an Haqaiq al-Adwiya) between 968 and 977. Undoubtedly, the most significant work of the three was that of Akhawayni Bokhari, the Hidayat. Herein, we review the teachings of Akhawayni on sleep paralysis (night-mare) along with a glimpse at those of the Greek, medieval, and Renaissance scholars in this regard. To avoid confusion with the modern use of the term ‘nightmare’ (a long frightening dream waking the dreamer), the term “night-mare,” with a hyphen, is used throughout this paper to designate sleep paralysis.