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Restless Nights
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Restless
Nights
Understanding Snoring and Sleep Apnea
P E R E T Z L A V I E
Translated from the Hebrew by Anthony Berris
Yale University Press New Haven and London
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The information and suggestions in this book are not intended to
replace the services of your physician or caregiver.Because each person
and medical situation is unique,you should consult your physician for
answers to your personal questions,to evaluate any symptoms you
may have,or to receive suggestions on appropriate medications.
The author has attempted to make this book as accurate and up-to-date
as possible,but it may nevertheless contain errors,omissions,or
material that is out of date at the time you read it.Neither the author
nor the publisher has any legal responsibility or liability for errors,
omissions,out-of-date material,or the reader’s application
of the medical information or advice in this book.
First published in Hebrew in 2002 by Yedioth Ahronot Books,
Chemed Books,Tel Aviv.
Copyright © 2003 by Yale University.
All rights reserved.
This book may not be reproduced,in whole or in part,including
illustrations,in any form (beyond that copying permitted by
Sections 107 and 108 of the U.S.Copyright Law and except
by reviewers for the public press),without written
permission from the publishers.
Designed by Sonia Shannon
Set in Bulmer type by Integrated PublishingSolutions
Printed in the United States of America by R.R.Donnelley & Sons.
Library of Congress Cataloging-in-Publication Data
Lavie,P.(Peretz),1949–
[Leylot lelo nachat.English]
Restless nights : Understanding snoring and sleep apnea / Peretz Lavie ;
translated from the Hebrew by Anthony Berris.
p.; cm.
“First published in Hebrew in 2002 by Yedioth Ahronot Books,
Chemed Books,Tel Aviv”—T.p.verso.
Includes bibliographical references and index.
ISBN 0-300-08544-3 (alk.paper)
1.Sleep apnea syndromes.2.Snoring.
[DNLM: 1.Sleep Apnea Syndromes.
2.Snoring.WF 143 L411L 2003a]
1.Title.
RC737.5.L3813 2003
616.2—dc21 2003002411
A catalog record for this book is available from the British Library.
The paper in this book meets the guidelines for permanence and
durability of the Committee on Production Guidelines for
Book Longevity of the Council on Library Resources.
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For Lloyd R.,
for his faith, support, and friendship
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Contents
Preface ix
1 The Breath of Life 1
2 Respiratory Control 13
3 The First Pickwickian 21
4 Rediscovery of the Pickwickian Patient 37
5 Western Innovations 53
6 The Dog Dropped Off and the Experiment Woke Up 64
7 From an Exotic Syndrome to a Public Health Issue 79
8 Risk Factors for Sleep Apnea 90
9 The Syndrome’s Symptoms 115
10 The Price of Awakenings 126
11 At the Temple of Morpheus 135
12 Children and Sleep Apnea 151
13 Sleep Apnea,the Heart,and the Blood Vessels 166
14 From Baroreceptors to Free Radicals 179
15 Death at an Early Age and the Paradox of Old Age 188
16 Treatments for Sleep Apnea Syndrome 195
17 Sleeping Under Pressure—The Big Promise 212
18 A Whole New Understanding 227
References 241
Index 253
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Preface
One of the questions gnawing at those engaged in sleep medicine,who
meet dozens of people suffering from sleep apnea syndrome every week,
is,Where have all these people come from,and where have they been
hiding all these years? A perusal of the medical literature seemingly
shows that sleep apnea syndrome did not exist until the 1970s. Al-
though descriptions of people who suffered from excessive sleepiness
had appeared in medical literature earlier,they were viewed as rare cases
associated only with extreme obesity.Once the syndrome was first de-
scribed in medical literature,more than twenty years elapsed before its
prevalence was recognized and defined as a public health problem.
Today we know that one in every ten men,and one in every twenty-five
women,suffers from sleep apnea syndrome; 80 to 90 percent of all the
patients who spend nights at sleep laboratories throughout the world are
there because they are suffering from sleep apnea.
Although a cursory look at the medical literature would seem to
suggest that sleep apnea syndrome is a fairly recent phenomenon,in fact
it has a long and fascinating history.In a sense,it had been hiding in plain
view,and trying to find an explanation for this curious history is what got
me started down this path.How could a syndrome with such obvious
symptoms—loud snoring at night and severe,even obsessive,assaults of
sleepiness during the day—have eluded the sharp scrutiny of genera-
tions of doctors?
I had started researching the subject during a sabbatical I spent at
Harvard University in 1984. Even then I discovered the existence of
solid evidence that doctors had been familiar with breathing disorders
during sleep at least a hundred years before the syndrome was first
described in medical literature.But being so engrossed in nineteenth-
century medical literature I neglected to devote attention to the more re-
cent history of the syndrome,and especially to the question of who con-
ducted the first laboratory sleep examinations in patients who stopped
breathing in their sleep.Aided by friends and colleagues,I successfully
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