July 13, 2000 -- In what could be the sleeper story of the year, a physician in Philadelphia proposesthat German composer Johannes Brahms, best known for his "Lullaby," may have suffered from obstructive sleep apnea (OSA), a serious disorder that could account for his notoriously irascible personality. "I am only too often reminded of the fact that I am a difficult person to get along with," he once wrote.
Brahms, who was born in Hamburg, Germany, in 1833 and died in Vienna, Austria, in 1897, is just the latest in a series of towering historical figures who have fallen victim to the phenomenon of "diagnosis-in-hindsight."
For example, Joan of Arc was said to have heard voices that floated to her on the wind. Diagnosis: schizophrenia. Abraham Lincoln was thin and gangly, had a droopy eye, and poor blood circulation. He was often photographed wearing a shawl. Diagnosis: Marfan's syndrome, a connective-tissue disorder that can include those symptoms.
And in what may be the most undignified example, researchers from the Mayo Clinic suggested in 1988 that Napoleon Bonaparte may have met his empire-crushing defeat at Waterloo thanks to clotted hemorrhoids, commonly known as "piles."
But Brahms? Baritone George Henschel, who had the misfortune to bunk with the great composer on a concert tour in the 1880s, recorded that a few seconds after Brahms blew out his candle, "the room was fairly ringing with the most unearthly noises issuing from his nasal and vocal organs." Add this to contemporary reports of the composer's nearly pathologic lack of social skills, his obesity late in life, and his anatomy -- he had a thick, short neck. The signs all point, tentatively at least, to obstructive sleep apnea.
"I conclude that the hypothesis that Johannes Brahms suffered from OSA is tenable, and that OSA could help explain some important aspects of his life and personality," writes Mitchell L, Margolis, MD, in the July issue of the journal Chest.
"I've always had interest in matters musical and I read books and anecdotes about composers from time to time," says Margolis, who is also an amateur pianist, in an interview with WebMD. "I was reading one about Brahms and it really sounded like he snored very heavily: I just made the connection, and wondered, since he was such a crabby guy in many of the anecdotes, could he have had sleep apnea?"
Like the other giants of history cited here, Brahms did not die from his retrospectively discovered condition; he is thought to have suffered from cancer of the pancreas. Similarly, Napoleon probably succumbed to arsenic poisoning, Lincoln -- as every school child knows -- from an assassin's bullet, and Joan of Arc, from, well, let's just say too much smoking.
But had cancer not taken him, Brahms could easily have died from the consequences of obstructive sleep apnea, which is a serious and potentially life-threatening illness. According to the National Heart, Lung, and Blood Institute (NHLBI), sleep apnea "is a breathing disorder characterized by repeated collapse of the upper airway during sleep, with consequent cessation of breathing. Virtually all sleep apnea patients have a history of loud snoring. They may also unknowingly experience frequent [awakening] during the night, resulting in chronic daytime sleepiness or fatigue."
Obstructive sleep apnea is a common condition, affecting an estimated 30 million Americans, but it is far more serious than simple tossing and turning. People with obstructive sleep apnea actually stop breathing during sleep for more than 10 seconds and as long as two or three minutes -- try holding your breath for that long! The NHLBI cites estimates that 4% of middle-aged men and 2% of middle-aged women could have obstructive sleep apnea. People who are obese, particularly in the neck, are particularly at risk.
Although they are often unaware of the problem, people with obstructive sleep apnea may experience fatigue, drowsiness, memory and judgment problems, irritability, difficulty concentrating, and personality changes. Apnea can also contribute to high blood pressure, which is reported in up to 50% of patients, and serious disturbances of heart rhythms, which are cardiac arrhythmias that can lead to heart attacks or strokes.
Symptoms of sleep apnea include chronic, loud snoring; gasping or choking episodes during sleep; excessive daytime sleepiness, car or work-related accidents, personality changes, or difficulties in thinking or concentrating related to fatigue.
"One wonders if the disorder contributed to lifelong alienation from friends and marriage, thereby indirectly nurturing his determined devotion to the creation of his immortal music," writes Margolis, who is with the division of pulmonary and critical care at the Philadelphia Veterans Affairs Medical Center.
That Brahms viewed marriage with a jaundiced eye is well known. "I never married, unfortunately, and thus I remain single, thank God," he is quoted as saying. And it's also documented that he was "prickly," as Margolis contends.
"Johannes Brahms had no social graces, he was intensely rude, and he was incapable of understanding his social blunders," says Julia Figueras, music director for the classical music station WXXI-FM in Rochester, N.Y., in an interview with WebMD.
Those less-than-admirable character traits could simply be chalked up to the thousand natural quirks that artistic souls are heir to. But put them together with reports of the composer's predilection for looking for sleep in all the wrong places -- he dropped off to dreamland during his first meeting with Franz Liszt, while that fiery young composer was thundering away on the piano in performance of his B minor sonata -- and the physical evidence, and it draws a portrait of a man profoundly troubled with a serious sleep disorder, Margolis says.
Apnea or no, music historians are unanimous about the significance of Brahm's compositions, naming the composer as the rightful successor to the mantle of Bach and Beethoven. As to the question of Brahms' social skills, or lack of them, few music lovers, if any, are likely to lose sleep over it.
For more information from WebMD, visit our Disease and Conditions Sleep Disorders page.