The fat boy, Joe, in The Pickwick Papers is Charles Dickens’ most popular creation among sleep researchers. He falls asleep at every opportunity. In this extract, Joe even sleeps through a battle that is being re-enacted for the entertainment of the local gentry.
Then there was such a ramming down of the contents of enormous guns on the battery, with instruments like magnified mops; such a preparation before they were let off, and such an awful noise when they did go, that the air resounded with the screams of ladies … Everybody was excited, except the fat boy, and he slept as soundly as if the roaring of cannon were his ordinary lullaby. ‘Joe, Joe!’ said the stout gentleman, when the citadel was taken, and the besiegers and besieged sat down for dinner. ‘Damn that boy, he’s gone to sleep again. Be good enough to pinch him, sir—in the leg, if you please; nothing else wakes him—thank you. Undo the hamper, Joe.’ The fat boy, who had been effectually roused by the compression of a portion of his leg between the finger and thumb of Mr Winkle, rolled off the box once again, and proceeded to unpack the hamper.
In Joe, Dickens described the symptoms of a person with possible obstructive sleep apnea (OSA) decades before scientists did. The Pickwick Papers was written in
1836–1837. A detailed scientific description of OSA came 40 years later from a London physician, WH Broadbent, in 1877.
Snoring and other disturbances during sleep have been with us forever, and they have been noted since ancient times. The Ptolemy dynasty in Egypt is said to have had a genetic tendency to obesity and sleep disorders. It has been suggested that Napoleon Bonaparte, Queen Victoria and both Theodore and Franklin D Roosevelt, U.S.A presidents, had OSA. But it was not until the 1950s that the cycles and body movements of sleep could even be recorded, and 1981 before continuous positive airway pressure (CPAP) treatment was developed.
Sleep apneas and sleep clinics
In 1965 the first polysomnograph recorded apneas during sleep. In 1970 the first sleep clinic was established at Stanford University, California, U.S.A, by William Dement. In 1972 Christian Guilleminault joined the clinic, concentrating on respiratory disorders during sleep.
The following five-year period, 1975–80, was an intense time of research into sleep and apneas with 319 articles appearing in the medical literature. In 1978 medical researchers located the source of the obstruction during OSA, proving that the airway was closing at the oropharynx, not further down in the larynx as previously believed.
1 Dogs with masks
In Toronto, Canada, Eliot Phillipson had started investigating respiratory control in dogs in 1970. He was joined in 1976 by Colin Sullivan on a post-doctoral research fellowship from the University of Sydney, Australia. In 1979 Sullivan returned to Sydney and devised a mask that would fit over a dog’s snout to deliver air or a gas.
Soon, he was able to extend his experiments to humans, creating masks from a plaster cast of each patient’s nose.
In 1981 Colin Sullivan used his observations of five patients to write a paper that would revolutionize the treatment of OSA.
2 He describes how his patients’ long histories of noisy snoring and excessive daytime sleepiness had seriously affected their lives. Two had lost their jobs as a result of falling asleep during worktime, and one boy of 13, was unable to stay awake at school and so had been categorised as ‘mentally retarded’. Sullivan conducted three all-night sleep studies on each patient, using CPAP on the third night. He showed that obstructive sleep apneas could be reversed by using CPAP to keep the airway open.
This short paper opened up a whole new world of treatment. Prior to this, people with severe OSA had to have a tracheotomy, which involved surgery to create an opening in their throat. Now, they had a treatment that required no surgery and no disruption to their life. They could breathe through the night and
The CPAP revolution
Medical researchers and scientists started to see the possibilities of this new form of treatment. Over the next 20 years, study after study built up evidence on OSA throughout
In 2000, four separate articles were published that demonstrated associations between OSA and hypertension. This was a turning point in sleep apnea studies. Treating OSA
was no longer just about relieving daytime sleepiness—there was the probability that it had a larger benefit to health as well. In 2001, further research showed an increased risk of coronary heart disease, heart failure, and stroke when a person’s apnea-hypopnea index is equal to or greater than 5 per hour.
3 From the earliest CPAP devices,
hand-built from pumps and pool tubing, we now have a wide choice of user-friendly, streamlined devices treating a range of conditions. Colin Sullivan’s revolution is still unfolding, as the effects of sleep apnea are more commonly recognised and effectively treated. For a piece of medical research, that’s a lot to happen in 30 years.
Did you know that some states and territories provide a rebate on your electricity if you use a CPAP or ventilation device? These devices are classed as life support machinery. For example, the NSW Government, Life Support Electricity Rebate offers 16 cents per day for PAP (positive airway pressure) devices.
You may also be prioritised for your service to be reinstated after a power failure. Contact your local electricity supplier to determine your eligibility.
Two had lost their jobs as a result of falling asleep during worktime, and one, a boy of 13, was unable to stay awake at school and so had been categorised as ‘mentally retarded’.
1. Remmers JE, De Groot WJ, Sauerland EK, Anch AM. Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 1978;44(6):931–8.
2. Sullivan CE, Berthon-Jones M, Issa FG, Eves L. Reversal of Obstructive Sleep Apnoea by Continuous Positive Airway Pressure Applied through the Nares. Lancet 1981;1(8225):862-5.
3. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, O’Connor GT, Boland LL, Schwartz JE, Samet JM. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19-25.