Sleep Technology

On a snowy day in 1975, Allan Rechtschaffen came into the conference room at the University of Chicago Sleep Research Laboratory and told me I should join a group called the Association for the Psychophysiological Study of Sleep. He said there was an annual meeting and some other stuff that would make it worth my while. The other graduate students started to chant, “Do it! Do it!” and so, succumbing to peer pressure, I joined my first professional society. (Author’s note: I’m not sure it really happened that way. It was a long time ago. My memory for what I just had for breakfast is hazy, so you can imagine what is left of my 1975 memories. But something like that did happen. I think.) I’ve been a member ever since.

I worked in neurology departments during my sleep center days. We were a friendly group and usually all had lunch together. I remember one day our chair, Nicholas A. Vick, came into the room and told us that he had just finished giving the annual neurology lecture to the newly installed emergency medicine residents. He said that he had started off with his usual question: “When is an MRI appropriate in the emergency room?” The reply from the residents: “When the patient has a head.” Hilarity ensued. Of course, some thought needed to go into the ordering of a $2,000 test. Not everyone with a head needed an imaging study. But at the same time, it reminded me of our PAP therapy mantra, which I attribute to Phil Westbrook: “When in doubt, pressurize the snout.” We had the feeling that PAP therapy, whenever used, would first do no harm. Well, partner, that ended in 2015.

As a graduate student at the University of Chicago, I had the distinct pleasure to work with Allan Rechtschaffen. He famously said, “If sleep doesn’t serve an absolutely vital function, it is the biggest mistake evolution ever made.” But he was pessimistic that his research in sleep deprivation and the physiology of sleep would ever find that function.

I’m a big fan of Sleep Review. It’s a good way to keep up with all things sleep related like technology developments, business prospects and scientific advances. It’s attractive and well-written. But a recent headline sent me into full-out grumpy old man mode.

  I was a postdoctoral fellow at Argonne National Laboratory and had the pleasure of working with George Sacher. At the time, he was president of the Gerontological Society of America and had spent his life working on ways to increase lifespan. He was a proponent of hormesis, the idea that moderation was the path to a longer life. Of course, some things should be off the list, like a moderate amount of murder. 

I often start the day with great expectations. I’ll finish the syllabus for my upcoming Sleep and Dreams class. I’ll write a blog or two. I’ll put together a Case of the Month. I’ll clean out the closet that filled up with boxes when we moved last year and hasn’t been touched since then. I’ll brew up some potent coffee to stimulate my thinking. I’ll sit down in front of my computer. I’ll check the email. I’ll look at a few pictures of cats stumbling around on catnip. I’ll shuffle a few lecture slides around. I’m ready for a nap.

During my site visiting years, I spent a considerable amount of time on planes reading accreditation applications. One thing that always puzzled me was that many centers included high and low ranges for sleep stages as a percentage of total sleep time. Despite the fact that my site visiting hit its peak in 2010, I think these numbers usually came from the 1974 opus by Williams, Karacan and Hirsch, which appears to be out of print. Patients with inadequate Stage 3 or excessive REM were branded as abnormal. But abnormal how?

Murray Johns developed the Epworth Sleepiness Scale (ESS) and published his methodology in 1991. (1) He subsequently tested its reliability in a group of 104 medical students (2) and found a test-retest correlation of r = .82. For those of us who are fans of Karl Pearson and his product-moment correlation coefficient (and I know there are many fans out there), this is a very large correlation and indicates that the measure is reliable.

My travel budget is limited, and I’m sure yours is as well. When I can’t make it to a meeting, I can always get the meeting to come to me through AAST’s Learning Center. I can watch and learn in the comfort of my own home. I can pause to take the dog for a walk, grab a snack from the fridge or whatever. Here are a few of my favorites from recent courses:

Every healthcare professional walks into the examination room with predetermined biases regarding the patients they see. Fifty-year-old obese man? OSA, of course. Twenty-year-old woman with daytime sleepiness? Could be narcolepsy. A man comes to the sleep center with his wife and she has a black eye? REM behavior disorder (RBD) is suddenly on your radar.