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Alumni Profile

Howard Roffwarg: A Scientific Champion of Sleep

By Peter Wortsman

Dr. Howard Roffwarg
Dr. Howard Roffwarg
Howard Roffwarg’58 has devoted his professional life to the study and protection of one of America’s most endangered and least appreciated natural resources: sleep.

Sleep has long been mystified as a fearful terra incognita, misunderstood as the brain’s state of shutdown, maligned as a waste of time. Nothing could be further from the truth. According to Dr. Roffwarg, sleep or, more precisely, rapid eye movement (REM) sleep, the stage during which dreaming takes place, is in fact an active physiological state second only to waking and vital to the development and maintenance of the central nervous system. That speculation, set forth in a pathbreaking paper, “Ontogenetic Development of the Human Sleep-Dream Cycle” (Science, 1966), sparked the emergence of an international field of research into REM-sleep neurophysiology in young mammals. Dr. Roffwarg and his colleagues are engaged in ongoing animal experiments, with preliminary positive results, to substantiate his hypothesis.

A Tireless Investigator and Clinician

Dr. Roffwarg in the Sleep Disorders Center at the University of Mississippi Medical Center
Dr. Roffwarg in the Sleep Disorders Center at the University of Mississippi Medical Center
Tireless is the best word, apparent paradox notwithstanding, to describe a man whose single-minded quest over the past 40 years has been to understand what happens when we catch 40 winks—and why some of us can’t.

A pioneering researcher on the physiology and functions of REM sleep, Dr. Roffwarg has simultaneously played a leading role in establishing sleep medicine as a recognized subspecialty and raising the national consciousness to the hazards of sleep deficiency. He chaired the committee of the American Sleep Disorders Association that wrote and published the first diagnostic classification system of sleep disorders in 1979, opening the way for the official recognition of the field of sleep medicine and its assignment of a subspecialty code by the AMA. He was among those whose testimony helped persuade Congress in 1994 to establish the National Center on Sleep Disorders Research housed in the National Heart, Lung, and Blood Institute at the NIH.

From Psychoanalysis to the Science of Sleep

Dr. Roffwarg with colleague Dr. Jeanetta Rains
Dr. Roffwarg with colleague Dr. Jeanetta Rains
Dr. Roffwarg’s intellectual quest and his interest in medicine were first sparked by a youthful fascination with Freud. Picking up some writings by the founder of psychoanalysis back in high school, Dr. Roffwarg recalls, “I really felt Freud understood the human mind in a way that was revolutionary, and that this revolution would spread around the world, helping people to perfect themselves and make this a better world.”

That early infatuation was tempered some in the course of his studies at Columbia College and later at P&S, where he was elected president of his class and where he honed his observational and diagnostic skills. Following a medical internship at Stanford, and briefly considering a career in internal medicine, Dr. Roffwarg returned instead to New York to pursue a residency in psychiatry at the New York State Psychiatric Institute. And while he would come to question many of Freud’s premises and conclusions, Dr. Roffwarg defends his own early naivete as a sine qua non for learning. “I’m not ashamed of being naive. We’re all naive before we know.”

Following a fortuitous intuition, he attended a lecture at the New York Academy of Medicine that would change his life. Scanning the announcements on a bulletin board at PI as a young resident, he remembers being intrigued by the subject, “dream deprivation,” and by the oddly appropriate name of the speaker, Dr. William Dement. Dr. Dement would become world famous as a member of the team of investigators who discovered and first described the phenomenon of REM sleep. By the close of that lecture, Dr. Dement had outlined his REM-deprivation experiments and Dr. Roffwarg had found a mentor and a mission. “A light went on in my brain,” Dr. Roffwarg still vividly recalls. “I had always wanted to do something creative, to be involved in acquiring some new knowledge. This was it and I wanted in at the ground floor!” The thrill hasn’t worn off yet.

With the kind permission of Dr. Lawrence C. Kolb, chairman of psychiatry at P&S, Dr. Roffwarg took a six-month leave from his residency to pursue research with Dr. Dement on the relationship of eye movements to dreaming.

REM Sleep, the “Royal Road to the Unconscious”

Three individuals working together, now legendary in the field of sleep research—Nathaniel Kleitman, Eugene Aserinsky, and William Dement—are credited with the initial observation and measurement of REM sleep. The first two are credited with discovering in 1953 the periodic and highly charged bursts of rapid eye movements during sleep. Aserinsky, a young physiologist at the time, devised a method for effectively measuring the electrical force of these movements. When awakened during these periods of rapid eye movement, the subjects experienced vivid dream recall, but awakened at other times they remembered next to nothing of the dream experience. It was Dr. Dement in 1955 who succeeded in designating those periods of eye movement, employing attendant brainwave recordings, as a discrete stage of sleep, distinct from the far less active non-rapid eye movement (NREM) phases of sleep. Dr. Kleitman had been unaware of this nightly sleep phenomenon when he wrote his monograph, “Sleep and Wakefulness,” in 1939.

Dement, a medical student at the University of Chicago and the junior member of the team, took the ball and ran with it, appreciating the psychological and scientific implications of the REM phenomenon as a physiological marker for dreaming, “the royal road to the unconscious.” Prompted by the New York psychoanalyst Charles Fisher, Dement continued to test his observations in clinical studies while pursuing an internship at Mount Sinai in New York. Enter Howard Roffwarg.

To Sleep Like a Baby

Dr. Roffwarg with colleagues Dr. Terry Brown and Dr. Jeanetta Rains
Dr. Roffwarg with colleagues Dr. Terry Brown and Dr. Jeanetta Rains
First author of a paper published in 1962 in the Archives of General Psychiatry, while he was still a resident, Dr. Roffwarg showed that eye movements in REM sleep correlated precisely with the visual imagery of dreams. He also collaborated with Dr. Dement on a study documenting “the influence of the laboratory situation on the dreams of the experimental subject.”

In 1962 he was named instructor in the Department of Psychiatry at P&S and took charge of the Sleep Electroencephalography Laboratory at PI. Dr. Roffwarg’s work attracted attention and in 1963 he was awarded the Joseph Mather Smith Prize for Most Meritorious Research of a P&S alumnus.

With the aid of a primitive EEG machine and the cooperation of young mothers, Drs. Roffwarg and Dement launched a study in the newborn nursery at Presbyterian Hospital, recording the sleeping patterns of neonates, ostensibly—“talk about naivete!” he chuckles—“to learn when dreaming begins.” It was already known from earlier recordings that REM sleep comprised on the average 20 percent to 25 percent of the sleep of adults. What he and Dr. Dement discovered completely amazed them: Newborn after newborn kept showing between 40 percent and 60 percent REM sleep. And while the adult takes up to 90 minutes to enter REM, the neonates went directly from waking into REM sleep 70 percent of the time.

Looking back in a 1998 lecture given at the scientific session of the P&S alumni reunion weekend, Dr. Roffwarg recapped his early surprise: “Through the ages, mothers have believed that after feeding, as the infant lies there in repose, gurgling and smiling, arching an eye, that he’s expressing contentment with the feeding. In fact, it has nothing to do with nourishment; he’s simply gone into rapid eye movement sleep and all the facial expressions are simply part of the phasic muscular discharge activated by the brain in REM sleep.”

Dr. Roffwarg was familiar with early experiments in a physical developmental field formerly called “stimulus-induced development” and now called “activity-dependent development” of brain and central nervous system tissue. Physiologists had shown in animal experiments that stimulation of sensory input results in quicker potentiation and maturation of neural centers and, conversely, deprivation of sensory input leads to a slowdown. It also had been demonstrated that the pivotal stage of development of the central nervous system takes place in the first two years of life, a period that, Dr. Roffwarg realized, was simultaneous to the time of maximal REM sleep.

Thus, he asked, “Since neonates have more REM sleep than adults, a fact true of all mammals, could it be that REM sleep plays a role in the development of the central nervous system?”

With the awe of a research scientist of markedly humanistic anlage, Dr. Roffwarg reflected on “whether the Great Maker may have put this process deep in the brainstem, which comes to maturation early, to help the rest of the brain grow to a point where it can handle the exigencies and the rush of sensory input of waking life.” Might it be, furthermore, Dr. Roffwarg conjectured, “that the pre-preparation of those areas of the central nervous system with the endogenous stimulation of this stage” pave the way for “what we know in our adult life as dreaming?” As the organism matures, he posited, REM sleep might very well have a CNS maintenance function.

But Dr. Roffwarg, the neurophysiologist, never abandoned his psychiatric roots and interest in the mind. He readily conceded that “dreaming is a physiological state . . . the cap on the iceberg, a psychological top level of a brain state of tremendous activity, thus the source of imagery.” He viewed “imagery and mentation as a dependant variable.” Never denying the cognitive element and psychological themes in dreams, he focused on their brain trigger.

We Dream the World as We See It

Dr. Roffwarg with colleague Dr. James Shaffery
Dr. Roffwarg with colleague Dr. James Shaffery
In a subsequent study that Dr. Roffwarg calls “the red goggle experiment,” written up in 1978 as a chapter of “The Mind in Sleep” (Arkin, Antrobus and Ellman), he devised an objective and systematic method of appraising at least one aspect of subjective experience in dreaming, the dimension of color.

Freud maintained that color in dreaming was linked to the emotional. In part to put the Freudian premise to a scientific test, Dr. Roffwarg had his subjects wear custom-fitted color-filtered welder’s goggles day and night, which transmitted only red-orange-yellow wavelengths, blocking the blue-green spectrum. “We wanted to put color in the background of the dream,” he says, “just to create an atmospheric tint . . . to see whether the representation of color in the dream came from the experience but not the dramatic intrusion of color in waking life.”

The proportional amount of redness the subjects reported in their dreams increased in the course of the experiment, whereas the dreaming of blue-green colors declined, thus demonstrating a simple but unproven truth—that “we dream the world as we see it.” In fact, the red lenses made the environment look like a black and white movie viewed through red lenses. Vividly red objects looked pinky-red as did white and gray objects. One distressed subject, greatly enamored of hamburgers, was so disgusted by the pinkness of both “actual” and dreamt ketchup under red goggles that he almost became a vegetarian.

In subsequent studies, Dr. Roffwarg explored the correlation between slight “phasic” activity during REM sleep (a period otherwise marked by the total absence of muscle tone) and dreamed movement. Also considering the auditory dimension of REM sleep, he showed that middle ear muscles, which ordinarily contract only in response to loud sounds in the waking state, likewise do so in REM sleep only in response to the “hallucinated” loud sounds in the dream.

Among his other research projects, Dr. Roffwarg worked on the relationship between sleep disorders and depression. He also has consulted with major pharmaceutical companies on their development and marketing of sedative-hypnotic and anti-depressant agents, most notably, Lilly’s Prozac (fluoxetine). Despite its benefits as a mood enhancer, Prozac impedes sleep, Dr. Roffwarg found.

Helping to Put Sleep Medicine on the Map

From 1966 to 1977, Dr. Roffwarg taught on the faculty in the Department of Psychiatry at Albert Einstein College of Medicine, where he rose to the rank of professor and supervised the Sleep Research Laboratory at Montefiore Hospital.

In 1977, he joined the psychiatry faculty of the University of Texas Southwestern Medical School in Dallas, simultaneously serving as director of the Sleep Study Unit and director of research for his department.

In sleep medicine as in sleep research, following the lead of his old mentor, William Dement, who had founded the first sleep disorders clinic at Stanford in 1979, Dr. Roffwarg established and ran the Sleep/Wake Disorders Center at U.T. Southwestern and Presbyterian Hospital of Dallas.

In 1995, he moved to Jackson, Miss., where he was named professor of psychiatry and human behavior and director of the Division of Sleep Medicine at the University of Mississippi Medical Center.

Publishing extensively, he served a tenure as editor-in-chief of Sleep Reviews, a journal of critical reviews of sleep articles published by the Brain Information Service.

Dr. Roffwarg also took on professional leadership roles in the field. From 1985 to 1987, he officiated as president of the Sleep Research Society, and from 1989 to 1991 he served a term at the helm of the American Sleep Disorders Association.

Dr. Roffwarg also played a leadership role in enhancing public awareness of the dangers of sleep-disruptive (and sometimes life-threatening) medical conditions, such as obstructive sleep apnea and sleep-inducing conditions like narcolepsy, through Project Sleep.

On the academic front, he has participated in an ongoing effort to educate physicians on matters relating to sleep and to expand and enrich medical school curricula in sleep medicine.

His honors include the 1977 Pioneer in Sleep Research Award of the Sleep Research Society and the 1981 Nathaniel Kleitman Prize for Distinguished Service from the American Sleep Disorders Association, of which he was the first recipient.

Married to Joy Hogge, Ph.D., director of the Adolescent Crisis Center of Catholic Charities in Jackson, he has two children from a previous marriage and twin grandchildren.

Following the advice of a Columbia alumnus, dispensed early on in his academic career, to “Be too busy!” Dr. Roffwarg continues to do just that, while trying not to miss his zzzz’s.

Alumni News Editor: Marianne Wolff, M.D.Alumni News Writer: Peter Wortsman
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