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In patients with obstructive sleep apnea, nightmares, narcolepsy, parasomnias, and other sleep disorders, service animals may add a valuable, and currently underappreciated, treatment option.
As sleep specialists, we spend our patient contact time on issues related not only to adherence to the treatments we prescribe, but also on trying to understand the motivations and behavioral choices our patients make that affect their sleep. Part of this clinical endeavor is to further understand how we can use patient decision-making preferences to help guide and direct treatment, which at times can present a major challenge. In Western cultures, an increasingly prevalent patient choice is the practice of co-sleeping with pets.
It is the objective of this paper to describe not only the habits of co-sleeping, but also the use of service animals (SA), usually dogs, and of emotional support animals (ESA) as promising treatments of various sleep disorders, and to promote further interest in this area by sleep professionals. Not only are SAs apparently being more widely utilized for this purpose, but there may be other benefits to the treatment of sleep disorders that have been only initially explored. Dogs appear to be the most readily available and trainable SA for most disorders. In recent years, there has been growing use of ESAs as well, who tend to be specifically used to provide support for psychiatric conditions such as panic anxiety and depression. Unlike SAs, these animals do not require formal training, but nor are they legally protected for public access.
Historical Perspective
In order to properly understand the phenomenon of co-sleeping, we are best served by reviewing the history of our relationship with dogs and cats, as well as our (questionably unique) capacity of empathy for other species. Animal-human co-sleeping has a fascinating anthropological history. The earliest co-habitant of man was the dog. The domestication of the dog has been traced as far back as the Paleolithic era, about 31,000 years ago 1 to 32,100 years ago.2 It is well-known that cultural patterns impact the sleep environment. In Western countries, the popularity of domestic pets has been increasing, and also rapidly expanding in westernizing cultures such as Japan. Over 70% of Americans own pets. Though most of the data on co-sleeping and bed-sharing lack...