Via books such as Principles and Practice of Sleep Medicine and a teaching position at the Yale School of Medicine, Meir Kryger, MD, measures his legacy not by what he personally achieved, but by how he helps others.
In 1973, a young medical resident walked into a ninth floor hospital room at the Royal Victoria Hospital in Montreal and saw something quite unexpected. His sleeping patient, who had been admitted for seizures, was struggling to breathe. The patient had stopped breathing and then started again!
The resident was Meir Kryger, MD, who would go on to become one of the most well known sleep medicine physicians in the world and one of the three editors of Principles and Practice of Sleep Medicine, the most widely used textbook in the field. However, at the time, there was no such area of organized medicine as sleep. Indeed, there was not even a true medical term for the type of sleep apnea Kryger was observing in the patient in the ninth floor hospital bed.
Fortunately for the field of sleep medicine, of all the people who could have happened upon that patient’s startling symptom, Kryger may have been one of the few to recognize its significance and be able to act on what he was seeing. By a stroke of luck, Kryger had encountered a similar obese patient with extreme sleepiness as an intern. In addition, he was at an academic institution where he had colleagues with the right equipment and training to further monitor the patient’s symptoms, as well as an attending physician, Nick Anthonisen, MD, willing to listen to his conclusions about the patient based on what Kryger had read in a handful of European medical journals.
“I go to [Anthonisen] and say that I think we need to do a tracheostomy on this guy in order to get him to breathe while he is sleeping,” Kryger recalls. “That was a pretty aggressive thing to come out of the mouth of a resident, to say that I think we need to put a hole in this guy’s throat in order for him to breathe again. But he listened and said, ‘If you think this will solve this person’s problems, go ahead and arrange that.’”
The morning after the tracheostomy, the patient was alert, awake, and the seizures that were occurring while he slept had stopped. Kryger’s write-up of the case would become the first documented case of sleep apnea in North America.1
“It is almost like my life has been a series of flukes, and here I am,” Kryger says.
He Who Brings Light
Meir is a Hebrew name that means “bright one” or “he who brings light.” Kryger says he sees himself as bringing light in the form of knowledge on many fronts, including through his own research, his teaching, his fostering of an exchange of ideas through his books, and his mentoring of the next generation of sleep researchers and clinicians.
“I love to teach, and if someone contacts me and wants me to give a talk, unless I have a good reason not to do it, I will give the talk,” he says.
He is also understandably proud of Principles and Practice of Sleep Medicine. The textbook just came out in a sixth edition and now includes 171 chapters (there were 78 chapters in the first edition). Among his many notable achievements, this book, first published in 1989, truly illuminated the emerging field of sleep medicine.
“It is the most comprehensive and interdisciplinary textbook reconciling the current basic science and clinical knowledge on sleep,” explains Gilles Lavigne, DMD, PhD, dean of the faculty of dental medicine and Canada Research Chair in pain, sleep and trauma at the University of Montréal and Sacre Cœur Hospital.
The other meaning of the name Meir—bright one—is also accurate, attest his colleagues, who praise his extraordinary intelligence and exceptional character.
“He is a very kind person and an incredible human being,” says internationally recognized sleep expert Max Hirshkowitz, PhD, formerly of Baylor College of Medicine in Houston. When Hirshkowitz first met Kryger as a young researcher, Hirshkowitz was not sure he wanted to pursue research because leading researchers he’d met were often aggressively ambitious. Kryger showed him you could be successful and a leader while also being patient, thoughtful, and open-minded with others.
“Whether he was doing research or putting together Principles and Practice of Sleep Medicine, he had to be very diligent, but he did it with compassion toward others and this has always impressed me,” Hirshkowitz says.
Charles George, MD, director of the Sleep & Apnea Assessment Unit? at London Health Sciences Centre at Victoria Hospital in Ontario, was a trainee under Kryger during the years when Kryger was putting together the first edition of Principles and Practice of Sleep Medicine. He still remembers the lessons he learned about how to treat trainees as equals and how to manage numerous disparate tasks.
“He is able to multitask like few people I have met in my life,” George says.
Canada to Colorado and Back
After the success of the tracheostomy for the Royal Victoria Hospital patient, Kryger was hooked on sleep. There was little known about it, so he says he felt like an explorer arriving in a new world.
“There are people who are attracted to the unknown,” he says. “I’ve always been interested in science, physics, philosophy, and going into an area that was really unknown did not seem odd to me, although I will admit that a lot of people found that it was a crazy thing to do to go into a field like sleep that didn’t look like it was going to go anywhere.”
He completed research fellowship training focusing on the upper airway at McGill University’s Meakins Christie Labs—quite accidentally picking the exact part of the anatomy that would turn out to be key to obstructive sleep apnea. From there, he and his new bride, Barbara, moved on to the University of Colorado Medical Center in Denver in 1974 for his fellowship training in pulmonary medicine and an opportunity to do research on high-altitude sleep. “We spent our first anniversary in Leadville, a town at 11,000 feet above sea level,” he says.
Along with Barbara’s help as an unofficial research assistant and partner, he was grateful for the support he received there from John Weil, MD, his mentor, and Thomas Petty, MD, head of the pulmonary section at the University of Colorado.
“I have been extraordinarily lucky in that I somehow ended up with mentors who wanted to explore and who were interested in new things and in innovation,” he says.
After completing his pulmonary fellowship followed by 2 years of research training, Kryger was recruited by Anthonisen to return to Canada and ultimately become a professor of medicine at the University of Manitoba. There he established the Sleep Disorders Centre at St. Boniface Hospital Research Centre in Winnipeg, which was the first clinical sleep laboratory in Canada.
Research and Writing
Kryger’s lab became well known for research. It was the first to show the feasibility of using noninvasive techniques to ventilate post-polio patients in their homes. In addition, Kryger contributed to clinical understanding of how sleep-disordered breathing can interact with heart disease.
Over the years, Kryger has published more than 200 research articles, book chapters, and books, including The Mystery of Sleep, the Atlas of Clinical Sleep Medicine, and Kryger’s Sleep Medicine Review. He has also been a leader in the establishment of the sleep medicine field, having at various times served as president of the Canadian Sleep Society, president of the American Academy of Sleep Medicine, and a member and chair of the Board of Directors of the National Sleep Foundation.
However, what he is best known for is Principles and Practice of Sleep Medicine, a book he first began working on in 1985 because he believed researchers and clinicians needed one place where they could find all they needed to know about sleep and sleep medicine, and because he was not scared off by the seeming impossibility of creating such a book in a pre-electronic publishing era.
“The first edition was almost entirely done on paper and mostly after hours,” he says. “There were some people who tried to dissuade me and said that there isn’t a field and there is not enough information to fill a book so don’t waste your time, but the way I look at challenges is that I don’t see them as barriers. A lot of people might have said, ‘He is crazy,’ but I didn’t look at it that way. I looked at it as something that needed to be done and I could do it.”
Helping him were his coauthors Thomas Roth, PhD, and William “Bill” Dement, MD, PhD, whose disciplines (psychology and psychiatry, respectively) underlined the very multidisciplinary nature of sleep. Although each edition of the book has been a tremendous amount of work, Kryger says that one of the pleasures of being the book’s chief editor is it has allowed him to collaborate with researchers from so many different backgrounds.
“I’ve had a wonderful opportunity to interact with really smart people from all over the world who have contributed to this book,” he says. “The book is designed to teach other people, but I’ve also learned an enormous amount in being the conductor of this marvelous orchestra.”
Mark Rosekind, PhD, an internationally recognized expert on sleep and fatigue who heads the National Highway Traffic Safety Administration, notes that the book is part of Kryger’s larger legacy of being a “translator” of sleep research both inside the field itself and for the general public. “There was this huge need for this book and he found a way to make it happen,” Rosekind says.
Sleep Mystery Still Entices
Kryger was drawn to sleep research because so little was known about sleep, and he still finds the mystery of sleep, especially the question of why we sleep, incredibly engaging.
“Sleep continues to be a frontier,” he says. “There are new things that are being discovered on the scientific front and the clinical front all the time…and clinically, every patient I see is kind of an adventure. The patient comes in with a problem and they may fall into a category that I recognize and know, like sleep apnea, or they may have symptoms that are an enigma and I may have to sort it out. There is still that element of mystery and adventure about sleep patients.”
However, although he greatly enjoys research, clinical practice, and writing, Kryger also wants to pass the torch to a next generation. In 2011, he joined the Yale School of Medicine and the VA Connecticut Health System. He says he loves his role as sleep fellowship program director at Yale because he is dealing with young trainees who want to learn. “That is just so wonderful,” he says. “The sum total of all of my teaching is in a sense my largest achievement.”
Although he has been awarded numerous awards over the years, including the William C. Dement Award for Academic Achievement from the American Academy of Sleep Medicine and the Distinguished Scientist Award from the Canadian Sleep Society, one of the prizes he is most proud of is the Mary A. Carskadon Outstanding Educator Award for 2013 from the Sleep Research Society (SRS).
“He is a natural teacher,” adds Naftali Kaminski, MD, chief of the Yale School of Medicine Pulmonary, Critical Care and Sleep Medicine department where Kryger works. “His excitement about sleep is infectious.”
Having had great mentors himself, Kryger hopes he has been a good mentor to others, and considers himself indeed very lucky to have had the chance to live at a time when sleep medicine was coming into its own.
“When you look back at your life, you wonder what if that hadn’t happened or this hadn’t happened,” Kryger says. “Dr Roth, who is a coeditor with me and a tremendous friend, survived the Holocaust as a very small child and became a huge luminary in sleep. My parents also survived the war and I was born shortly after, a displaced person without a nationality. Our family ultimately moved to Canada. People might say that was fate. But if it hadn’t been me, somebody else would have done the same as I did. The things I did might have come a little later, but they would have come, because they would have had to have come. I look at it as that I was lucky to be at the right place at the right time.”
Lena Kauffman is a Sleep Review contributor and former editor based in Ann Arbor, Mich.
1. Kryger M, Quesney LF, Holder D, Gloor P, MacLeod P. The sleep deprivation syndrome of the obese patient. A problem of periodic nocturnal upper airway obstruction. Am J Med. 1974 April;56(4):530–539.