Sleep disorders have received growing public and scientific attention in the last decades. Scientific research and publications on sleeplessness are ongoing and considerable progress has been made on the medical understanding of sleep. And yet, insomnia affects an ever-growing number of people around the globe and remains both a difficult and common complaint general practitioners have to deal with on a daily basis. Sleeplessness is not new, although its transformation from a state of accepted wake to that of exasperating insomnia is a relatively recent transition in which, this article argues, Western medicine took an active part. In the 19th century, the theorisation of different nervous disorders and later of neurasthenia shaped the transformation of insomnia from a constituent of everyday life into a pathology. Based on research in French medical journals published in the second half of the 19th century, this article retraces a succession of medical paradigms for sleeplessness, including ‘symptomatic insomnia’, ‘nervous insomnia’ and interestingly, ‘insomnia’ as a key element in neurasthenia theories. The analysis of medical discourse in all successive theories reveals the decisive influence of physicians in the medicalisation of insomnia, their sociocultural representations echoing patient’s complaints as well as professional imperatives.

AIMS OF THE STUDY: Controlled drinking as a therapy goal for problematic alcohol use is still a matter for debate, especially with regard to dependent drinkers. Furthermore, few structured controlled drinking programmes have been evaluated. The aim of this study was to observe the evolution of excessive and dependent drinkers in a French-language six-step controlled drinking programme called "Alcochoix+". METHODS: This was a cohort study of patients in four centres in the French-speaking part of Switzerland who were enrolled between May 2010 and September 2011, and evaluated before and up to 1 year after completion of the programme, according to criteria such as drinking habits, evolution of the Alcohol Use Disorder Identification Test (AUDIT) score and quality of life indicators. We considered the patients who chose not to be followed up to have unchanged alcohol consumption. RESULTS: Recruitment was slow: 60 persons were enrolled, mostly middle-aged men, with excessive alcohol use / moderate alcohol dependence (median AUDIT score 20.5, median weekly alcohol consumption 350 g). Thirtyfour participants (56.7%) completed the programme and their median weekly alcohol reduction was 160 g. The mean AUDIT score decreased to 14.1 points. Several aspects of quality of life improved. Changes were stable 1 year after the programme. Expressed satisfaction with the programme was high.CONCLUSIONS: This six-step structured controlled drinking programme designed for excessive drinkers also attracted moderately dependent drinkers. Those who had participated fully in the study significantly reduced their alcohol consumption, with a slight improvement in their quality of life. Future studies should identify the barriers to problem drinkers integrating controlled drinking programmes, and to underline the role of these programmes for moderately dependent drinkers.

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Our data are in line with studies using single direct assessment of intravascular volume 1-3 or functional assessments. 4 Single measurements preclude detection of individual changes. We have assessed such changes and demonstrate that no clinically relevant losses in total blood volume occur. We excluded patients with conditions predisposing to hypovolaemia. They include a broad range of conditions from obvious to the very subtle than occur especially in the elderly.Our findings lay the physiological basis for current goaldirected strategies of peri-operative fluid administration that explicitly preclude initial fluid loading and significantly reduce adverse outcomes. Vice versa, our data show that preventive administration of large volumes of intravenous fluids during induction of general anaesthesia to compensate for erroneously presumed fluid losses lack scientific reason.