The Nightmare, 1781 Henry Fuseli

Founders Society Purchase with funds from Mr. and Mrs. Bert L. Smokler and Mr. and Mrs. Lawrence A. Fleischman

Photograph © 1997 The Detroit Institute of Arts

Deep within Emory Hospital, past the darkened lobby, in a zone marked “Quiet,“ lies the Sleep Disorders Center. Patients start showing up about 8 p.m., carrying small totebags with their pajamas and toothbrushes. Among them this humid July night is Clarke Weigle, a forty-five-year-old computer administrator in Atlanta.

“I tend to fall asleep at the drop of a hat,“ Weigle says. “Once I fell asleep onstage while singing with a symphony. A month ago, I fell asleep at work while on hold on my phone with tech support. They had to shout to wake me.“

Although Weigle says he has never fallen asleep while driving or in other situations where it could be dangerous, he does feel tired during the day and would like to find a solution. His doctor recommended that he come to Emory, where about one thousand patients a year are observed in sleep labs.

“What makes Emory’s sleep program unique is that we have both clinical and research expertise–and the expertise cuts across disciplines, from nursing to neurology to mental health to aging,” says Associate Professor of Neurology David Rye, medical director of the Emory Hospital sleep lab.

Tonight, Weigle and two other men are spending the night in the lab to be tested for sleep apnea, which causes an individual to stop breathing repeatedly during sleep–sometimes hundreds of times a night and often for a minute or longer. Consequently, sleep is extremely fragmented and of poor quality.

Apnea is one of the most common disorders seen at the center; others include insomnia, restless leg syndrome, narcolepsy, and sleep problems associated with illnesses like epilepsy and Parkinson’s disease.

“My wife says I snore and that I do seem to stop breathing at times during the night,” Weigle says, settling into the single bed to watch a rerun of Law and Order on the wall-mounted television as he might at home. “I’m sure I won’t have a problem falling asleep here. I tend to fall asleep pretty quickly.”

The sleep lab consists of four standard hospital rooms, each with a bed, chair, sink, television, and a computer monitoring station. Tonight, sleep technicians Keith Pew and Teresa Bryant are on duty. They work from 7 p.m. to 7 a.m., three nights a week.

After hooking up Weigle to multiple electrodes, Pew closes the door and flips on a computer that displays Weigle’s brain waves, eye movements, chin movements (to detect teeth grinding), pulse, heart rate, leg motion, airflow resistance in his chest and stomach, and his blood’s oxygen level. A microphone placed below his throat broadcasts snoring noises, and an infrared camera sends a video image to the monitor. All data are stored for later review and interpretation.

Night after night, Pew and Bryant observe the idiosyncrasies and frustrations of sleep patterns gone awry.

“I have had patients who don’t sleep all night–one man actually got up and wandered around the hospital. Other patients say they won’t sleep all night, then fall asleep in one minute,” Bryant says. “And some of them, after sleeping for eight hours, believe they only slept for about an hour.”

“Some of our patients,” adds Pew, “say they sleep better here than they do at home.”

Indeed, when patients are awakened at the lab at 6 a.m., many complain about being roused and ask to sleep in.

“They want to stay until 8 or 9 a.m., have breakfast and a little coffee,” says Bryant, laughing. “But Keith and I have been up all night and are ready to go home and sleep!”


For centuries, sleep has been viewed as both a human need and a human weakness. The early Greeks believed that sleep separated mere mortals from the more vigilant gods. In folklore, people were entranced by sleep, put to sleep with spells, or–as in the case of Rip Van Winkle–slept their lives away. Theories abounded as to what caused our nocturnal slumber and its strange visions: warm “vapors” rising from the stomach, a build-up of toxic wastes or a cooling of the blood, the brain “shutting down.” The sleeper was thought to be in a mystical realm between wakefulness and death.

“Sleep is a powerful force, one that can have an extremely positive effect on overall health or, when reduced in quantity and quality, can have extraordinarily detrimental effects,” says Associate Professor of Nursing Kathy Parker (below), a fellow in the American Academy of Sleep Medicine who conducts research through Emory’s Sleep Disorders Center in the Department of Neurology.

The nature of sleep is still not fully understood. But since rapid eye movement (REM) sleep was discovered fifty years ago, much progress has been made in discerning sleep’s architecture–its cycles, stages, and physical characteristics. In the mid-1950s, sleep was found to consist of two distinct states: non-REM and REM. REM sleep is lighter, characterized by irregular breathing, an increased heart rate, and dreaming. Also, a type of “paralysis” overcomes the sleeper, perhaps to prevent any acting out of dreams.

In the 1960s and ’70s, sleep labs thrived, but the research was thought to be an intellectual exercise with no practical applications. As sleep disorders were discovered, sleep medicine evolved as a clinical and academic specialty.

Emory has eight primary faculty in its sleep program, as well as collaborating researchers and fellows. In addition to the sleep lab in Emory Hospital, there is a four-bed sleep lab at Emory’s Wesley Woods Geriatric Hospital, under the direction of Professor of Neurology Donald L. Bliwise, and a four-bed pediatric sleep lab at Egleston Hospital/Children’s Healthcare of Atlanta. Sleep studies, which include human and animal subjects, attract more than $2 million in research funds to the University annually.

“When Dave Rye and I arrived here in 1992, there was little sleep research and a very small clinical program,” says Bliwise. “We’ve experienced phenomenal growth, similar to the field of sleep medicine itself. At Wesley Woods, we’re studying sleep apnea in Alzheimer’s disease and muscle activity in Parkinson’s disease during sleep.”

Sleep disorders are prevalent in America; more than one in three people say they have suffered insomnia, which is clinically defined as taking longer than thirty minutes to fall asleep. The causes of sleep disorders can be physical, but they can also be cultural. In our frenetic society, sleep is viewed as a negotiable commodity, condensed into an all-too-brief period between late-night television and early-morning alarm.

“Time spent sleeping is often believed to be time wasted,” Parker says. “But a well-rested individual is clearly more productive, has less depression and anxiety, performs better on a wide variety of tasks, is safer on the road, and has a better quality of life.”

Parker finds that college students who complain of insomnia are often practicing poor “sleep hygiene.” By going to bed later and sleeping later, their bodies adjust to, for example, a 3 a.m. to noon sleep cycle. When they try going to bed earlier, they end up lying awake for hours, unable to fall sleep.

“This can have serious consequences,” Parker says. “We’ve had people flunk out of school because of this.”

On the other end of the spectrum, senior citizens tend to have more fragmented, less efficient sleep. The amount of deep sleep decreases with age, while time spent in bed increases. “With our elderly patients it’s often a matter of re-education, such as limiting naps,” Parker says.

Medicines are not recommended as permanent solutions for sleep disorders, but there are new drugs available, such as Ambien, that target specific neurotransmitters and have few side effects. These can be used for up to two weeks during situations of acute stress, jet lag, or bouts of severe insomnia.

“Prior to the 1990s, sleep medicines had lots of side effects and problems. Some people who took barbiturates mixed with alcohol died,” Parker says. “The new medicines, however, can be very appropriate as short-term sleep aids.”

Many sleep disorders seem to have a genetic component. Studies have shown, for example, that narcolepsy and restless leg syndrome tend to run in families.

Narcolepsy, a rare disorder that affects about one in two thousand, causes overpowering feelings of sleepiness and fatigue during the day. Restless leg syndrome (RLS), a more common condition that may be experienced by up to 10 percent of the population, is described as an overwhelming urge to move one’s legs when inactive, a tingling or creeping sensation in the legs while lying down, and involuntary jerking of the legs during sleep.

Rye, who is board certified in sleep medicine and chair-elect of the RLS Foundation Medical Advisory Board, is currently conducting genetic research with the biotech company Decode on RLS in Iceland.

“We benefit by being able to study a homogeneous population with a wealth of genealogical and medical records. And, in turn, we enhance the power of Decode’s gene-mining strategies by adding information from our diverse population here in the Southeast,” says Rye.

On his office computer, Rye pulls up a diagram showing three generations of an Icelandic family. The pattern is clear: clusters of individuals reporting the symptoms of restless leg syndrome show up in sibling groups and throughout generational lines. Volunteers are observed overnight in a temporary sleep lab in Iceland to make sure they fit the diagnosis of RLS.

To observe and monitor a sleeping patient, Rye says, is to have a “fingerprint of their brain activity. Any abnormality can be an indicator of a serious problem.”

Yet, he adds, many sleep disorders still go undiagnosed because doctors don’t ask about them and people don’t report them.

And so, much of sleep remains as mysterious as when it was considered a gift granted by the Greek god Hypnos, who, carrying a branch dripping with dew from the river of forgetfulness, “flew on shady wings over the world sending all breathing nature to its rest.”

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© 2003 Emory University