Dr. David Rapoport, director of N YU Langone’s Sleep Disorders
Center, monitors a patient undergoing a sleep study.
doesn’t collapse while you’re awake because muscles
hold it open. For reasons we don’t understand, that
muscle tone is lost when we go to sleep. The airway, if
it’s prone to collapse, is sucked shut when you breathe
in. In milder cases, the airway only vibrates, and the
sound that comes out is snoring. In more severe cases,
it collapses, and you wake up to prevent suffocation.
This cycle can repeat as often as every 30 to 60 seconds.
A Conversation with Dr. David Rapoport, Director of
NYU Langone’s Sleep Disorders Center
Each year, more than 1,500 people seek help from NYU Langone Medical Center’s Sleep
Disorders Center. Some have problems falling asleep (insomnia) and a growing number suffer
from sleep apnea, a breathing disorder in which their upper airways become obstructed during
sleep. David Rapoport, MD, associate professor of medicine and the center’s medical director,
has pioneered research into the nature and treatment of sleep apnea for more than 30 years.
Why is it so hard for so many of us to get a good
Sleep is basically a habit. The more you stick to a bedtime routine, you better you sleep. In the old days, your
internal clock was set by sunrise and sunset. Then we
invented the electric light. Now we’re up all night doing
e-mail. After a stressful day, you fret about the next day.
Our lives are increasingly filled with distractions that
break us out of what should be a very habitual cycle.
improve. The same may be true for memory. Hence the
phrase “Let’s sleep on it.”
Can’t we all get used to surviving on little sleep—the way
medical residents or truck drivers do?
They don’t get used to it. They might think they do, but
they don’t. As a species, we are very good at managing
sleep deprivation for a short time, but we’re not designed
to do it all the time. When you don’t sleep, you build up
a debt that you have to pay back, sooner or later.
What are the long-term risks if it’s untreated?
We believe sleep apnea predisposes to high blood
pressure, heart attacks, strokes, weight gain, even
death. We’re beginning to suspect that apnea may
play a role in metabolism. For example, we think sleep
apnea may make diabetes worse, and it appears to
change appetite and the way we handle glucose, possibly leading to weight gain. In addition, things that
cause other diseases, such as inflammation, seem to be
activated by sleep apnea.
What’s the Sleep Disorders Center’s approach to diag-
nosis and treatment?
Currently, 80% of our patients have sleep apnea, and
it doesn’t take long to confirm this. They sleep in a
comfortable room while we monitor their sleep patterns
and breathing. We often can make the diagnosis in the
first hour or two, then wake the patient and start treatment the same night. Most often, we fit them with a
mask attached to a continuous positive airway pressure
[CPAP] machine, adjusting the air pressure until sleep
and breathing become normal. When they go home
with the treatment, it takes a week or so to get used to
wearing it, but about 70% experience significant improvement. We treat patients with insomnia by teaching them good sleep habits, and the majority improve.
Why do we need to sleep at all?
There seems to be nothing useful about sleep. You lose
time. You become food for predators if you’re not careful. You wouldn’t choose to sleep unless it served an
incredibly important function. But we don’t know what
the ultimate purpose is on a cellular level. All we know
is that if you’re deprived of sleep, things start to go
awry. Concentration, mood, reaction time, judgment,
memory, learning, and perhaps metabolism are all
affected. Sleep must be important, because even very
simple animals seem to have a natural activity-and-rest cycle similar to sleep. We believe sleep in humans
is tied to pruning memory and learning. If I teach
you, say, how to shoot a basketball, you’ll practice,
practice, practice, and when I finally test you, you’ll
have retained a certain level of skill. If you sleep, the
next morning you’ll be better at that skill than when
you finished practicing. If you don’t sleep, you don’t
How can we help ourselves fall asleep more easily?
Put the day behind you. Develop a calm-down script,
and stick to it every single night. Quiet your mind and
stop focusing on daytime stress builders. Focus on
regularity and relaxation. Your body is already primed
for sleep. Allow it to happen.
Would we all be better off if we took a siesta, like they
do in southern Europe?
There’s a lot in our biology to suggest that siestas are
a natural rhythm. At about 4:00 p.m., our body says,
“It’s a good idea to take a nap.” When you’re sleep
deprived, that’s the time you’re most likely to nod off.
This afternoon hump means we’re hardwired for a
siesta. Some cultures have taken that to heart, but it’s
tough to sell here. Sadly, Europe is actually shifting to
the American model.
What about sex before sleep?
A limited number of studies suggest that for some
people, it’s very helpful. The activity itself revs you up,
but part of the release is actually predisposing to sleep.
Satisfying sex probably aids a good night’s sleep as
much as anything else.
How well do you sleep?
I used to be one of the lucky ones who slept well most
of the time. But one of the prices you pay for aging—
and having more work and stress—is that you sleep
less well. I’m no exception.
Note: Dr. Rapoport has served as a paid consultant for
a CPAP manufacturer.
But for people with sleep apnea, the trouble starts
after they’re asleep?
Right. If you think of your airway as a floppy tube, it
Web Extra: for an article about N YU Langone’s Sleep
Disorders Center, see “The Sandman in the White
Coat” at www.newsandviews-digital.com.
The Less Stressful Stress Test and Other Weekend Options (continued from page 1)
be a passing fad, but a fact of life at this institution,”
explains Andrew Brotman, MD, senior vice president
and vice dean for clinical affairs and strategy. “This
is what the public wants, and this is what we intend
to deliver as part of our patient-centered care—to
make comfort and convenience an integral part of the
experience at N YU Langone.”
Elective outpatient surgeries on the weekends
have more than doubled over the past year,
underscoring their growing popularity. Procedures
that can now be performed during off-peak hours
(usually Saturdays) include those in orthopaedic
surgery, bariatric surgery, urology, otolaryngology,
and gastroenterology. “Only about a quarter of
operating rooms are typically being utilized on
weekends,” notes Jeffrey Short, senior director of
strategy and business development. “So we have all
this capacity available for patients who would prefer
to have elective surgery on a weekend rather than
miss a day from work.” In addition to scheduling
convenience, weekend services offer the advantages
of less traffic and easier child care.
Because healthcare is so dependent on teamwork,
the move to more and more weekend services requires
a corresponding buildup of personnel. This enterprise
has traditionally been fueled by overtime hours, but
NYU Langone wants to ensure that whatever day
of the week it is, patients can expect the same high-quality medical care provided by the same highly
trained professionals. So the Medical Center is moving
toward a new model of hiring full-time employees
dedicated to both weekday and weekend hours.
At this point, the challenge is not only growing
the roster of weekend services, but also helping the
community to take full advantage of it. “It’s a big shift
in culture, so we have to work hard to change patient
perceptions,” says Seligman. “We want our patients
to know that if they or their child needs a test, they
no longer have to miss a day from work or pull the
child out of school. Seven-day-a-week services are the
future of healthcare, and N YU Langone is ahead of
January/February 2012 | page 3