Restless Nights: Understanding Snoring and Sleep Apnea
"There had to be a very special reason for doctors to agree to spend their nights in a laboratory observing the brain waves of a sleeping person." So Peretz Lavie writes in Restless Nights, his authoritative, highly readable, and personal narrative of the history of sleep research. "Special" are the reasons, insights, and accomplishments of the physiologists and clinicians who appear in the pages of this book: they have helped us to understand the cardiorespiratory, cognitive, psychological, and epidemiologic science involved in breathing disorders of sleep. In presenting a history of sleep-apnea research, Lavie highlights a paradox of modern medicine: that an elegantly elucidated syndrome of repetitive asphyxiation and sleep disruption does not necessarily command the immediate attention of the entire medical and research community, or indeed of patients themselves. If the section entitled "Falling Asleep Holding a Duck," which blends a historical perspective with modern insight to describe periodic breathing and sleep apnea, does not enthrall readers interested in physiology and medicine, then it is not clear what would. Here, Lavie quotes Dr. Richard Caton's observations from 1888 that portray a terrifyingly accurate model of what is indeed common among adults and children during sleep: The thorax and abdomen are seen to heave from fruitless contractions of the inspiratory and expiratory muscles; their efforts increase in violence for about a minute or a minute and a half . . . until at last, when the condition to the onlooker is most alarming, the glottic obstruction yields, a series of long inspirations and expirations follows, and cyanosis disappears. . . . The night nurses state that these attacks go on throughout the night. Lavie's discussion of cardiovascular links to sleep-disordered breathing is particularly compelling and should be eye-opening to primary care physicians and specialists alike. Also well treated are such topics as the epidemiology of sleep-disordered breathing, the development and refinement of treatments (both invasive and noninvasive) for sleep apnea, the future of sleep medicine, and education. The book may also disappoint, for it does not decisively target its audience. The title, subtitle, and associated blurb on the front cover ("Snoring and sleep apnea can be dangerous to your health") address the lay reader. The book, however, neither lists practical recommendations for patients at risk for sleep-disordered breathing nor serves as a consistently satisfying reference for the clinician, physiologist, or health-systems analyst; there are many instances in which the writing tends toward scientifically trivial phrases geared to the lay public. It is also disappointing that the book does not acknowledge the work of scores of clinicians and researchers who have made seminal contributions to our understanding of the physiology, pathogenesis, consequences, and treatment of sleep-disordered breathing. In the end, however, it is clear that much of the exhilarating insight of Restless Nights is fundamental not only to sleep medicine but to all of medicine. All readers who are interested in the optimal practice of medicine in the 21st century would be well advised to take notice.Robert C. Basner, M.D.Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.