In a recent interview with Elsevier Authors, Dr. Kryger discusses how he got into sleep medicine and how the field has grown over the years:
I decided to go into medicine when I was a kid. I don’t think anybody in my family had ever even gone to college, to be honest. My parents were Holocaust survivors and I was born a displaced person, without a nationality. I was always able to empathize with people who were sick, so I decided to become a doctor. I was actually pointed in that direction when my own father became ill and he needed some neurosurgery done. We were living in Montreal, and the person who operated on him was, at the time, the best known neurosurgeon in the world, a gentleman by the name of Wilder Penfield.
He was a giant in neurosurgery, and he was the first person who actually connected parts of the brain with your hand, or your foot and so forth. I remember him examining my father and his explaining to me what he was doing. My father had a subdural hematoma and Penfield is there with this little gadget that he puts onto my father’s head and I asked “What is that?” He said, “It’s a radar.” This was ultrasound in the 1960’s. The surgery was successful, and I decided then and there that I was going to do medical research. Ironically, when I did finally get into medical school and I had a lecture given by Wilder Penfield, he said “You can’t be a neurosurgeon unless you have really good hands.” I’m a bit of a klutz, and I realized that I didn’t have the dexterity to be a surgeon, so I did other things and eventually ended up in pulmonary medicine and sleep.
I’ve always carried a camera with me whenever I examine my patients, and if I find something interesting, I photograph the patient. I get their permission to use their photographs. I have interviews of patients as well. And the only way to learn about being a doctor, is you learn from your patients. So I have photographs, I have interviews, and I have actual records of patient studies that people can use to learn about their patients and how to treat them better.
It was quite a struggle within the first few years to get sleep disorders recognized as problems that needed to be dealt with medically, and now everybody knows someone who has a sleep disorder or is being treated for sleep disorder, and we need to remind people that until about 1975, the two words sleep and apnea together did not even exist. This is a very new field and it’s kind of exciting that we’re able to meet some of the original pioneers and some of the original researchers, many of whom luckily we had the opportunity to meet and have them contribute to the textbook.
In the early days of sleep medicine, it was really very difficult to get people who pay for healthcare to actually pay for these kind of services, so in the sleep lab I had in Winnipeg, in Canada, we saw patients with zero reimbursement for the first 12 years. That’s the way it was in a lot of places, with a lot of people working for universities. Even in the United States it took a long time for there to be reimbursement and even now the government and insurance companies run everything and tell you what you can bill for and what you can’t bill for. For many years, the criteria for treating sleep disorders in the US were so high: the apnea index was 30 or more in order to be reimbursed by Medicare. That’s 30 times an hour someone had to stop breathing. That rule basically excluded the treatment of most women who had sleep apnea, because most women stopped breathing not 30-35 times an hour, but 15 or 20 times an hour. Now the rules are much more reasonable, but for years and years we weren’t able to treat everybody.
One of the things about treating sleep disorders is that in the early days, very often you would hear these stories that were heart-rending and there was nothing that you could do to help things that had already happened. I remember this one woman who was sitting in my office, she was maybe 25 years old, and she had narcolepsy. Sometimes you ask a patient a question and you’re sorry when you hear the answer. I asked “Why are you here?” and she said that she was very sleepy, and I said “Well, why is that a problem for you?” She told that she fell asleep driving and her two-year-old daughter was killed. You hear a story like that and it’s like, why was she not diagnosed? It turned out that she had had symptoms for years and years, and nobody picked it up. That’s a real tragedy, because we can treat it.
Meir Kryger, MD is a physician and professor at the Yale School of Medicine. He is a renowned researcher and practitioner, whose research has spanned all areas of sleep breathing disorders. Dr. Kryger is an author of more than 200 research articles and book chapters, and he has been chief editor of the Principles and Practice of Sleep Medicine, 5th Edition since its inception. This text is currently in its fifth edition. Dr. Kryger is also an editor of Kryger’s Sleep Medicine Review and the Atlas of Clinical Sleep Medicine.
Dr. Kryger established the first laboratory to study patients with sleep breathing problems in Canada, and was the first to diagnose and report obstructive sleep apnea in North America. Dr. Kryger has served Chairman of the Board of the National Sleep Foundation and is a former president of the American Academy of Sleep Medicine and former president of the Canadian Sleep Society. He is a past recipient of the William C. Dement Academic Achievement Award for his contributions to sleep education and academic research.
